What should be the first management steps to be taken immediately upon admission of a patient with bleeding complications of antithrombotic treatment?
Mark Crowther, MD: The very first steps should be standard steps to ensure that the patient is safe. Things like assessing their airway, breathing, circulation; establishing intravenous access; obtaining a crossmatch in case the patient needs to be transfused; if the patient requires volume resuscitation or use of inotropes, intubation, ventilation, cardiac monitoring, transfer to an intensive care unit setting—that is all the first part of the management.
The second part of the management is to assess the patient’s laboratory results and to try and figure out why they are having bleeding complications. If the patient has profound anemia, they should be transfused. If they have profound thrombocytopenia, you may consider the use of platelet transfusion. If the patient is on an anticoagulant, you would want to use the history combined with the laboratory results to determine what antithrombotic is present and approximately how much is there.
If you believe that there is an antithrombotic present, and you believe that you have a drug or other strategy that can reverse it, then in the setting of severe or life-threatening bleeding you should think about whether or not you are going to use a specific or nonspecific reversal strategy.