2) I am Deborah Siegal MD MSc FRCOC @DebSiegal, a #hematologist @OttawaHospital, Tier 2 Canada Research Chair in Anticoagulant Management of Cardiovascular Disease, Associate Professor/Associate Scientist @uottawa pic.twitter.com/by15AJU9NP
— cardio-met (@cardiomet_CE) December 22, 2022
4) #Anticoagulants are used widely to prevent and treat #cardiovascular disease, a leading cause of death ☠️ and disability 🌎🌍🌏. pic.twitter.com/l6hx6UzjFy
— cardio-met (@cardiomet_CE) December 22, 2022
6) Whether #VKA or #DOAC, #OAC-treated patients with both intracranial and extracranial bleeding have an increased risk of ☠️compared to those without bleeding. pic.twitter.com/L41RyERZn6
— cardio-met (@cardiomet_CE) December 22, 2022
8) In fact, high mortality rates are seen after specific anticoagulant #reversal for major #GI bleeding in patients taking #dabigatran (idarucizumab in the #REVERSE_AD study) and factor Xa inhibitors (#andexanet_alfa in the #ANNEXA_4 study). pic.twitter.com/tNuyiOPfAc
— cardio-met (@cardiomet_CE) December 22, 2022
9b) He takes #apixaban for atrial fibrillation #AF and recently started using #naproxen for an ankle sprain. pic.twitter.com/qn8DJiPx8Z
— cardio-met (@cardiomet_CE) December 22, 2022
11) Using a structured approach to guide clinical management ensures optimal care delivery by identifying which patients are eligible for #reversal or #hemostatic therapies in addition to maximum supportive measures and definitive interventions. pic.twitter.com/fOQtUpA1cq
— cardio-met (@cardiomet_CE) December 22, 2022
13) #Reversal and hemostatic therapies should be used judiciously for emergencies such as serious bleeding or urgent surgery, when there is confidence that anticoagulation is contributing to the bleeding picture. pic.twitter.com/b7kLwLRjft
— cardio-met (@cardiomet_CE) December 22, 2022
15) Although routine coagulation tests like #INR, #PT, & #aPTT are not accurate or reliable for quantifying #DOAC levels, they can be helpful when used qualitatively. Clinical interpretation of lab test results is required! pic.twitter.com/JbMkwChriE
— cardio-met (@cardiomet_CE) December 22, 2022
17) So, to recap, patients with severe GI bleeding (e.g. hemodynamically unstable, delay in definitive procedural intervention) in whom clinically significant #DOAC levels are suspected or confirmed can be considered for reversal or hemostatic therapies. pic.twitter.com/iNGOuAESxa
— cardio-met (@cardiomet_CE) December 22, 2022
19) What are the treatment options for our patient with acute serious GI bleeding in patients on #FXa inhibitors? pic.twitter.com/XhLYOIQGS5
— cardio-met (@cardiomet_CE) December 22, 2022
21) It’s c. #Andexanet_alfa is an altered, biologically inactive #FXa decoy that reversibly binds #aFXa #anticoagulants. #4F_PCC is a repletion approach that includes all of the vitamin K-dependent coag factors (II, VII, IX, X).
— cardio-met (@cardiomet_CE) December 22, 2022
23) 4-factor prothrombin complex concentrate #4F_PCC is a human plasma-derived concentrate of vitamin K-dependent factors II, VII, IX and X approved for #warfarin reversal. In the setting of DOAC-related bleeds, 4F-PCC may enhance hemostasis by overcoming anticoagulant effect. pic.twitter.com/5FFdiA2Elk
— cardio-met (@cardiomet_CE) December 22, 2022
25) The limitations of available data leave uncertainty about the incremental benefits and harms of treatments and whether there are differences between treatments. pic.twitter.com/0ryJT2wskE
— cardio-met (@cardiomet_CE) December 22, 2022
27) After bleeding +/- reversal, despite an ongoing risk of #thrombosis, #anticoagulation is withheld for many patients. Those who restart #OAC appear to have a lower rate of thrombosis and higher rate of bleeding compared those who do not restart OAC. pic.twitter.com/dmRafcT1JY
— cardio-met (@cardiomet_CE) December 22, 2022
29) It is important to remember that the causes and consequences of #GI bleeding are heterogeneous, so there is no “one size fits all” approach. See 🔓https://t.co/RKR6cgDUoF pic.twitter.com/sEFCGecg8x
— cardio-met (@cardiomet_CE) December 22, 2022
31) Check out the @ACCinTouch ManageAnticoagApp https://t.co/htSM0AEDQ2 for more guidance about managing bleeding and restarting anticoagulation after bleeding. pic.twitter.com/iQeaIlL8w1
— cardio-met (@cardiomet_CE) December 22, 2022
33) 🔑 messages: #anticoagulant-related GI bleed management incorporates prevention, includes reversal/hemostatic therapies for severe bleeding, & considers re-starting anticoagulation when it is safe to do so. pic.twitter.com/ZfVmtFBzcG
— cardio-met (@cardiomet_CE) December 22, 2022
35) Did you respond “a”? This patient may need his anticoagulation regimen re-evaluated, +/- endoscopy, but is hemodynamically stable and his #anticoagulation should not be immediately reversed.
— cardio-met (@cardiomet_CE) December 22, 2022
36) You did it! Now go grab 0.5h CE/#CME credit by clicking to https://t.co/2Shck19I6z. Please take full advantage of this opportunity as we reach the end of the year 📅and you need that credit!
— cardio-met (@cardiomet_CE) December 22, 2022