Reversal of anticoagulation in the Intensive Care Unit: An international online survey – the ROTATION survey |
1. Introduction
Dear Colleague,
The ESICM Transfusion Guideline Task force is currently preparing the first international reversal of anticoagulation guideline specifically for bleeding adults in the intensive care unit (ICU) setting.
Anticoagulant medications are frequently used for preventing and treating thromboembolic events, resulting in encountering patients who need anticoagulation reversal to manage (major) bleeding or prior invasive procedures.
Reversal of anticoagulation in ICU patients is challenging because of diverse patient factors. Some factors could influence the balance of benefits and harms of reversal, such as diagnosis (trauma, intracranial hemorrhage, cancer), age, concomitant medications (e.g., platelet aggregation inhibitors), and comorbidities (e.g., renal or hepatic failure). In addition, monitoring of reversal of anticoagulant therapy in ICU patients is complex, due to accompanying coagulopathy as a result of the underlying condition.
The ESICM Transfusion Guideline Task force is currently preparing the first international reversal of anticoagulation guideline specifically for bleeding adults in the intensive care unit (ICU) setting.
Anticoagulant medications are frequently used for preventing and treating thromboembolic events, resulting in encountering patients who need anticoagulation reversal to manage (major) bleeding or prior invasive procedures.
Reversal of anticoagulation in ICU patients is challenging because of diverse patient factors. Some factors could influence the balance of benefits and harms of reversal, such as diagnosis (trauma, intracranial hemorrhage, cancer), age, concomitant medications (e.g., platelet aggregation inhibitors), and comorbidities (e.g., renal or hepatic failure). In addition, monitoring of reversal of anticoagulant therapy in ICU patients is complex, due to accompanying coagulopathy as a result of the underlying condition.
As there is no international guideline on this subject yet, this survey aims to assess ICU physicians’ current practices, especially during major bleeding, for anticoagulation reversal in the ICU including 1) different types of anticoagulants, 2) choices of anticoagulation reversal drugs and blood products, as well as 3) when to restart anticoagulant drugs. We hypothesize that within the adult ICU population, clinical practice vary between and within heterogeneous subpopulations.
Sincerely,
The ESICM Transfusion Guideline Task force
Steering Committee: Prof. dr. Alexander Vlaar, Prof. dr. Nicole Juffermans, Dr. Marcella Müller, Dr. Joanna Dionne, Dr. Simon Oczkowski, Drs. Maite van Haeren, Drs. Stefan van Wonderen
Conflicts of interest: A.V. is supported by a personal grant of NWO (VIDI Grant number 09150172010047). N.J. receives research support from Octapharma.
Conflicts of interest: A.V. is supported by a personal grant of NWO (VIDI Grant number 09150172010047). N.J. receives research support from Octapharma.