What are the recommended management strategies for a patient with acquired coagulopathy due to anticoagulant therapy?

Management of acquired coagulopathy caused by anticoagulant therapy primarily involves prompt identification and reversal of the anticoagulant effect to reduce bleeding risk and restore haemostasis. Initial steps include stopping the anticoagulant agent and assessing the severity of bleeding and coagulation parameters to guide further treatment ¹.

For vitamin K antagonists (e.g., warfarin), administration of vitamin K and prothrombin complex concentrate (PCC) is recommended for rapid reversal, especially in cases of major bleeding or urgent surgery ¹. Fresh frozen plasma (FFP) may be considered if PCC is unavailable, but PCC is preferred due to faster correction and lower volume load ¹.

In patients on direct oral anticoagulants (DOACs), specific reversal agents such as idarucizumab for dabigatran or andexanet alfa for factor Xa inhibitors should be used when available, alongside supportive measures ¹. If specific antidotes are not accessible, PCC or activated PCC may be considered based on clinical judgement (Hart and Schmid, 2016).

Supportive care includes maintaining haemodynamic stability, transfusion of blood products as needed, and monitoring coagulation status closely ¹. In intensive care settings, management may require multidisciplinary input and consideration of underlying conditions contributing to coagulopathy (Hart and Schmid, 2016).

In complex cases such as patients with left ventricular assist devices, acquired coagulopathy may be multifactorial, necessitating tailored anticoagulation adjustments and close monitoring to balance bleeding and thrombotic risks (Muslem et al., 2018).