Analysis of anticoagulation reversal survey (ARES)

ABSTRACT

Objectives

Despite the availability of FDA-labeled anticoagulant reversal agents, there is considerable variability in clinical practice as to the regimen and agent used for reversal. The objective of this study was to characterize the current practices of pharmacists surrounding the reversal of anticoagulant-associated life-threatening hemorrhage. Methods: A cross-sectional analysis of critical care and emergency medicine pharmacists. Current practice was compared for the type of hospital, country region, and type of ordering physician. In addition, pharmacists were asked to rank their involvement with activities involved with the reversal of anticoagulants. Respondents ranked their involvement with these activities as either never involved, rarely involved, occasionally involved, frequently involved, or always involved. Results:281 respondents were included. The majority used 4-factor PCC for warfarin reversal (92.9%) and factor Xa inhibitor reversal (79.7%). However, only 58.7% used the labeled dose of 4-PCC for warfarin reversal. Of the 30.6% that utilized a fixed-dose regimen, the most common regimen was 1500 units once. A higher proportion of respondents practicing in a teaching hospital reported that they used activated prothrombin complex concentrates for reversal of factor Xa inhibitor (22 [12.2%] vs. 5 [5%]; p < 0.05) or coagulation factor Xa (recombinant)-inactivated-zhzo (31 [17.2%] vs. 5 [5%]; p < 0.05). In addition, the majority of respondents utilized idarucizumab for dabigatran reversal. The only involvement activity in which <50% of respondents said they were frequently involved or always involved was ‘administration of reversal agent.’ Conclusions: There is considerable variability in which agents were utilized for anticoagulant-associated bleeding reversal.

KEYWORDS:

• Anticoagulants
• reversal
• surveys and questionnaires
• warfarin
• rivaroxaban
• apixaban
• dabigatran
• andexanet
• idarucizumab
• prothrombin complex concentrate

Declaration of interest

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Potential conflicts of interest

ASR is on the speaker’s bureau for Cheisi.

SD and LAH have no conflicts.

A reviewer of the manuscript has received research grants from Octapharma (a manufacturer of PCC). Another reviewer has acted as a consultant (March 2019) for Portola Pharmaceuticals. The final reviewer has received research grants and consultant fees from Portola Pharmaceutical.