1Īnti-fibrinolytic agents Tranexamic Acid (TXA)Consideration of the use of the anti-fibrinolytic agent TXA IV 15-30mg/kg, followed by a continuous infusion at 1mg/kg/hr until bleeding is under control in Factor Xa inhibitors. The patients’ blood group must be determined (or group AB plasma may be used) and the time taken for infusion are all be factors to be considered. The use of plasma requires the treating facility to have appropriate facilities for frozen plasma storage and thawing. FFP contains all coagulation factors present in whole blood but it is not a factor concentrate therefore multiple units may be required. Transfusion support Fresh Frozen Plasma (FFP)Replacement is required to correct the low levels of factors II, VII, IX and X induced by warfarin. The usual does is 5-10mg IV given as a bolus dose. 1 Its effect is not immediate but will progress over time as the liver synthesises sufficient quantities of coagulation proteins (factors II, VII, IX, X) dependant on Vitamin K. 6 The intravenous route achieves a more rapid response compared with oral administration, with an onset of action seen within 6-8 hours. Vitamin KVitamin K, given orally or intravenously (Phytomenadione) can be used to accelerate Warfarin reversal by counteracting its effects on Vitamin K-dependent coagulation factor synthesis. 13Įarly haematological advice from the MTS’s is recommended to guide management. Management Agents While the effects of Warfarin can be reversed, some of the newer oral anticoagulants do not have direct antidotes therefore management should focus on resuscitation and factor replacement.
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