Chris Baugh/LinkedIn
Oct 2, 2026, 11:20
Chris Baugh: Modern ED Strategies for Antithrombotic-Associated Bleeding
Chris Baugh, Chair Elect at Emergency Medicine Foundation, shared a post on LinkedIn:
“New paper in EB Medicine’s Emergency Medicine Practice: ‘Antithrombotic-Associated Bleeding: Management in the Emergency Department,’ co-authored with the incredibly talented Xin Qi and Annie Leamon.
Several points from the review that may change bedside practice:
- Resuscitation and hemorrhage control come first. Reversal runs in parallel and is not the initial priority.
- A normal INR or PTT does not exclude a DOAC effect. Drug-specific anti-factor Xa levels are needed, and a normal thrombin time effectively rules out a clinically significant dabigatran effect.
- Emergent warfarin reversal requires 4F-PCC plus IV vitamin K. Vitamin K alone is insufficient.
- With andexanet withdrawn from the US market, PCC-based replacement is the current strategy for factor Xa inhibitor reversal, though evidence for it remains limited.
- For antiplatelet-associated ICH, platelet transfusion is supported only when neurosurgical intervention is planned. In nonsurgical ICH, it offers no benefit and may cause harm.
- High thrombotic risk, such as a mechanical valve, does not automatically justify or preclude reversal. The decision weighs both risks.
The issue also covers periprocedural management, pregnancy, fibrinolytic reversal, and a clinical pathway for ED use.
It is eligible for 4 AMA PRA Category 1 Credits.”
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