Management of acquired coagulopathy caused by anticoagulant therapy primarily involves prompt identification and reversal of the anticoagulant effect to reduce bleeding risk and restore haemostasis. Initial steps include stopping the anticoagulant agent and assessing the severity of bleeding and coagulation parameters to guide further treatment NICE NG39.
For vitamin K antagonists (e.g., warfarin), administration of vitamin K and prothrombin complex concentrate (PCC) is recommended for rapid reversal, especially in cases of major bleeding or urgent surgery NICE NG39. Fresh frozen plasma (FFP) may be considered if PCC is unavailable, but PCC is preferred due to faster correction and lower volume load NICE NG39.
In patients on direct oral anticoagulants (DOACs), specific reversal agents such as idarucizumab for dabigatran or andexanet alfa for factor Xa inhibitors should be used when available, alongside supportive measures NICE NG39. If specific antidotes are not accessible, PCC or activated PCC may be considered based on clinical judgement Hart & Schmid 2016.
Supportive care includes maintaining haemodynamic stability, transfusion of blood products as needed, and monitoring coagulation status closely NICE NG39. In intensive care settings, management may require multidisciplinary input and consideration of underlying conditions contributing to coagulopathy Hart & Schmid 2016.
In complex cases such as patients with left ventricular assist devices, acquired coagulopathy may be multifactorial, necessitating tailored anticoagulation adjustments and close monitoring to balance bleeding and thrombotic risks Muslem et al. 2018.
Key References
- NG39 - Major trauma: assessment and initial management
- NG24 - Blood transfusion
- NG158 - Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
- (Hart and Schmid, 2016): [Coagulation disorders in the intensive care unit - what is new?].
- (Muslem et al., 2018): Acquired coagulopathy in patients with left ventricular assist devices.