Context

Anticoagulants are widely used in patients of all ages and co-morbidities for the prevention and treatment of thrombo-embolic disease. The primary complication of all anticoagulants is bleeding even when maintained at therapeutic levels. This bleeding can be catastrophic necessitating immediate or urgent reversal of a patient’s anticoagulation.

Unfractionated heparin (UFH), warfarin and Dabigatran are widely used anticoagulants and have specific antidotes for the reversal of anticoagulation.

There are a number of newer anticoagulants that currently have no specific reversal agent, and include factor Xa inhibitors such as rivaroxaban and fondaparinux[1,2].

In this module we will review the common anticoagulants used, discuss there mode of action and the steps used in the management of the bleeding or over-anticoagulated patient.