🩸 Anticoagulant-Related Major Bleeding Reversal
UseUse in major or life-threatening bleeding to pair the correct antidote with the drug class while applying gen…
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SourceTomaselli GF, et al. JACC 2020 ACC ECDP. doi:10.1016/j.jacc.2020.04.053
Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
- Who it is for
- Nonvalvular atrial fibrillation when deciding oral anticoagulation and the next step after bleeding.
- Who it is not for
- Valvular atrial fibrillation and mechanical valves do not use this card. Unrelated to PERC.
- Formula and variables
- Stroke risk uses CHA₂DS₂-VASc: heart failure, hypertension, age ≥75 (2), diabetes, prior stroke/TIA/embolism (2), vascular disease, age 65–74 and female sex, 1 point each. The 2024 ESC guideline uses CHA₂DS₂-VA without the sex item (≥2 recommend, 1 consider OAC); the 2023 ACC/AHA guideline still uses CHA₂DS₂-VASc (men ≥2, women ≥3). The 2023 China AF guideline uses CHA₂DS₂-VASc-60 (age 60–64 = 1, ≥65 = 2; OAC for men ≥2, women ≥3). This page scores the original CHA₂DS₂-VASc. Bleeding risk uses HAS-BLED.
- Result → next step
- Anticoagulation decisions open the atrial-fibrillation anticoagulation page: anticoagulate, hold for now, or individualize. A high bleeding score means fix reversible factors first; do not stop anticoagulation automatically. Bleeding opens the reversal page. No numeric reversal dose.
- Guideline
- China atrial fibrillation guideline 2023
Score + version; reference only — not a substitute for care · no HIS write
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Methodology · worked example, guidelines & full notes
Clinical takeaway
Specific antidotes are layered on top of universal first steps (stop the drug, mechanical hemostasis, transfusion support), not used in isolation. (original synthesis · not guideline verbatim)
When to use
Use in major or life-threatening bleeding to pair the correct antidote with the drug class while applying general measures and planning restart.
How it works
VKA → vitamin K + 4F-PCC (or FFP). Dabigatran → idarucizumab (or PCC/dialysis). Xa inhibitor → andexanet alfa (or 4F-PCC). Heparin → protamine (1 mg per ~100 U).
Key points
- Specific antidotes are layered on top of universal first steps (stop the drug, mechanical hemostasis, transfusion support), not used in isolation. (original synthesis · not guideline verbatim)
- Dabigatran is dialyzable, offering an additional removal route unavailable for the Xa inhibitors.
- After bleeding control, restart timing weighs thrombotic risk (e.g. mechanical valve favors earlier restart).
References
- [Guideline / primary source]Tomaselli GF, et al. JACC 2020 ACC ECDP. doi:10.1016/j.jacc.2020.04.053
- [Guideline / primary source]ISTH SSC 2024 doi:10.1016/j.jtha.2024.07.009
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Anticoagulant class | Dabigatran (direct thrombin inhibitor) |
|---|
→Antidote/reversalIdarucizumab
- Specific/preferred reversal：Idarucizumab IV (specific antidote, preferred); PCC/aPCC if not available; activated charcoal for recent ingestion, dabigatran is dialyzable
- General measures：Stop the anticoagulant immediately; mechanical/endoscopic/surgical/interventional hemostasis; transfusion and volume support, correct other coagulation abnormalities (platelets, fibrinogen); activated charcoal for recent oral anticoagulant
- After bleeding control：Assess thromboembolic risk and timing of anticoagulation restart (e.g. mechanical valve or recent high-risk VTE need earlier restart; low risk can defer or stop)
| Anticoagulant class | Warfarin / vitamin K antagonist |
|---|
→Antidote/reversalVitamin K + 4F-PCC
- Specific/preferred reversal：IV vitamin K + 4-factor prothrombin complex concentrate (4F-PCC, by INR/weight); fresh frozen plasma (FFP) if no PCC available
- General measures：Stop the anticoagulant immediately; mechanical/endoscopic/surgical/interventional hemostasis; transfusion and volume support, correct other coagulation abnormalities (platelets, fibrinogen); activated charcoal for recent oral anticoagulant
- After bleeding control：Assess thromboembolic risk and timing of anticoagulation restart (e.g. mechanical valve or recent high-risk VTE need earlier restart; low risk can defer or stop)
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Anticoagulant-Related Major Bleeding Reversal?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Anticoagulant-Related Major Bleeding Reversal upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Anticoagulant-Related Major Bleeding Reversal calculated in practice? Can you show a worked example?
- Inputs: Anticoagulant class Dabigatran (direct thrombin inhibitor) → Result: Antidote/reversal Idarucizumab（Specific/preferred reversal: Idarucizumab IV (specific antidote, preferred); PCC/aPCC if not available; activated charcoal for recent ingestion, dabigatran is dialyzable, General measures: Stop the anticoagulant immediately; mechanical/endoscopic/surgical/interventional hemostasis; transfusion and volume support, correct other coagulation abnormalities (platelets, fibrinogen); activated charcoal for recent oral anticoagulant, After bleeding control: Assess thromboembolic risk and timing of anticoagulation restart (e.g. mechanical valve or recent high-risk VTE need earlier restart; low risk can defer or stop)） Inputs: Anticoagulant class Warfarin / vitamin K antagonist → Result: Antidote/reversal Vitamin K + 4F-PCC（Specific/preferred reversal: IV vitamin K + 4-factor prothrombin complex concentrate (4F-PCC, by INR/weight); fresh frozen plasma (FFP) if no PCC available, General measures: Stop the anticoagulant immediately; mechanical/endoscopic/surgical/interventional hemostasis; transfusion and volume support, correct other coagulation abnormalities (platelets, fibrinogen); activated charcoal for recent oral anticoagulant, After bleeding control: Assess thromboembolic risk and timing of anticoagulation restart (e.g. mechanical valve or recent high-risk VTE need earlier restart; low risk can defer or stop)）