Table 4 summarizes the current antithrombotic
drugs, their mechanisms of action, and reversibility.
47,48 It is difficult to treat a bleeding patient
who is receiving an oral anticoagulant such as
dabigatran and rivaroxaban, since there is no
specific antidote. Studies that have evaluated the
reversal of the new oral anticoagulants have been
limited to reversal of drug effect with the use of
recombinant activated factor VII and prothrombin
complex concentrate. Current evidence suggests
that prothrombin complex concentrate may
be the best option and that it reverses the effects
of rivaroxaban better than the effects of dabigatran.
49,50 General measures such as stopping the
antithrombotic
medication, documenting the time
and amount of the last drug dose, and noting the
presence of renal and hepatic impairment are
suggested. Management may be aided by obtaining
a full blood count and hemostatic screening,
along with a specific laboratory test to measure
the antithrombotic effect of the drug, if available.
If the medication has been recently ingested
and there is no specific antidote, oral activated
charcoal may be given to absorb any residual
drug in the stomach.