ICU Cases · Haematology & coagulation
Hot case — the bedside: the life-threatening bleed on a DOAC
A CICM hot case on the DOAC reversal — the andexanet alfa (or PCC), the activated charcoal if recent, the resuscitation, and the source control.
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Prompt
A patient on apixaban presents with a massive GI bleed. Outline the immediate management including the reversal.
Presentation
You are called to the bedside of a 72-year-old woman on the apixaban 5 mg BD (for the atrial fibrillation) who has developed the massive haematemesis and melaena. Her blood pressure is 75/palpable, her heart rate is 130, and she is pale and clammy.[1]
References2ShowHide
- [1]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [2]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.