Definition of factor Xa inhibitor–related, life‐threatening gastrointestinal bleeding and guidance on when to use reversal therapy: A Delphi panel
Abstract Objective To define and contextualize life‐threatening gastrointestinal (GI) bleeding in the setting of factor Xa (FXa) inhibitor therapy and to derive a consensus‐based, clinically oriented approach to the administration of FXa inhibitor reversal therapy. Methods We convened an expert pane...
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Elsevier
2023-10-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.13043 |
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| author | Gregory J. Fermann Brooks D. Cash Nayantara Coelho‐Prabhu Marc Maegele Roland Bingisser Vinay Sehgal Alexander T. Cohen Anna Hundt Golden Jon Russo Mark Price Allen Mangel Bruce Koch Mary J. Christoph Truman J. Milling Jr. |
| author_facet | Gregory J. Fermann Brooks D. Cash Nayantara Coelho‐Prabhu Marc Maegele Roland Bingisser Vinay Sehgal Alexander T. Cohen Anna Hundt Golden Jon Russo Mark Price Allen Mangel Bruce Koch Mary J. Christoph Truman J. Milling Jr. |
| author_sort | Gregory J. Fermann |
| collection | DOAJ |
| description | Abstract Objective To define and contextualize life‐threatening gastrointestinal (GI) bleeding in the setting of factor Xa (FXa) inhibitor therapy and to derive a consensus‐based, clinically oriented approach to the administration of FXa inhibitor reversal therapy. Methods We convened an expert panel of clinicians representing specialties in emergency medicine, gastroenterology, vascular medicine, and trauma surgery. Consensus was reached among the clinician panelists using the Delphi technique, which consisted of 2 survey questionnaires followed by virtual, real‐time consensus‐building exercises. Results Hypovolemia and hemodynamic instability were considered the most important clinical signs of FXa inhibitor–related, life‐threatening GI bleeds. Clinician panelists agreed that potentially life‐threatening GI bleeding should be determined on the basis of hemodynamic instability, signs of shock, individual patient characteristics, and clinical judgment. Last, the panel agreed that all patients with life‐threatening, FXa inhibitor–associated GI bleeding should be considered for FXa inhibitor reversal therapy; the decision to reverse FXa inhibition should be individualized, weighing the risks and benefits of reversal; and when reversal is elected, therapy should be administered within 1 h after initial emergency department evaluation, when possible. Conclusions Consensus‐based definitions of life‐threatening GI bleeding and approaches to FXa inhibitor reversal centered on hemodynamic instability, signs of shock, individual patient characteristics, and clinical judgment. The results from this Delphi panel may inform clinical decision‐making for the treatment of patients experiencing GI bleeding associated with FXa inhibitor use in the emergency department setting. |
| format | Article |
| id | doaj-art-1270a691872e4c78bfdff0c178ab6aa6 |
| institution | Kabale University |
| issn | 2688-1152 |
| language | English |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-1270a691872e4c78bfdff0c178ab6aa62025-08-20T03:54:20ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522023-10-0145n/an/a10.1002/emp2.13043Definition of factor Xa inhibitor–related, life‐threatening gastrointestinal bleeding and guidance on when to use reversal therapy: A Delphi panelGregory J. Fermann0Brooks D. Cash1Nayantara Coelho‐Prabhu2Marc Maegele3Roland Bingisser4Vinay Sehgal5Alexander T. Cohen6Anna Hundt Golden7Jon Russo8Mark Price9Allen Mangel10Bruce Koch11Mary J. Christoph12Truman J. Milling Jr.13Department of Emergency Medicine University of Cincinnati Cincinnati Ohio USADivision of Gastroenterology, Hepatology, and Nutrition University of Texas Health Science Center at Houston‐McGovern Medical School Houston Texas USADivision of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota USADepartment of Trauma and Orthopedic Surgery Cologne‐Merheim Medical Center Institute of Research in Operative Medicine University Witten‐Herdecke Cologne GermanyDepartment of Emergency Medicine Universitätsspital Basel Basel SwitzerlandDepartment of Gastroenterology University College Hospital London London UKDepartment of Haematological Medicine Guy's and St. Thomas’ Hospital London UKRTI Health Solutions Research Triangle Park North Carolina USARTI Health Solutions Research Triangle Park North Carolina USARTI Health Solutions Research Triangle Park North Carolina USARTI Health Solutions Research Triangle Park North Carolina USAAstraZeneca Medical Affairs Wilmington Delaware USAAstraZeneca Medical Affairs Wilmington Delaware USADepartments of Neurology and of Surgery and Perioperative Care Dell Medical School Austin Texas USAAbstract Objective To define and contextualize life‐threatening gastrointestinal (GI) bleeding in the setting of factor Xa (FXa) inhibitor therapy and to derive a consensus‐based, clinically oriented approach to the administration of FXa inhibitor reversal therapy. Methods We convened an expert panel of clinicians representing specialties in emergency medicine, gastroenterology, vascular medicine, and trauma surgery. Consensus was reached among the clinician panelists using the Delphi technique, which consisted of 2 survey questionnaires followed by virtual, real‐time consensus‐building exercises. Results Hypovolemia and hemodynamic instability were considered the most important clinical signs of FXa inhibitor–related, life‐threatening GI bleeds. Clinician panelists agreed that potentially life‐threatening GI bleeding should be determined on the basis of hemodynamic instability, signs of shock, individual patient characteristics, and clinical judgment. Last, the panel agreed that all patients with life‐threatening, FXa inhibitor–associated GI bleeding should be considered for FXa inhibitor reversal therapy; the decision to reverse FXa inhibition should be individualized, weighing the risks and benefits of reversal; and when reversal is elected, therapy should be administered within 1 h after initial emergency department evaluation, when possible. Conclusions Consensus‐based definitions of life‐threatening GI bleeding and approaches to FXa inhibitor reversal centered on hemodynamic instability, signs of shock, individual patient characteristics, and clinical judgment. The results from this Delphi panel may inform clinical decision‐making for the treatment of patients experiencing GI bleeding associated with FXa inhibitor use in the emergency department setting.https://doi.org/10.1002/emp2.13043anticoagulant reversalfactor Xa inhibitorgastrointestinal hemorrhage |
| spellingShingle | Gregory J. Fermann Brooks D. Cash Nayantara Coelho‐Prabhu Marc Maegele Roland Bingisser Vinay Sehgal Alexander T. Cohen Anna Hundt Golden Jon Russo Mark Price Allen Mangel Bruce Koch Mary J. Christoph Truman J. Milling Jr. Definition of factor Xa inhibitor–related, life‐threatening gastrointestinal bleeding and guidance on when to use reversal therapy: A Delphi panel Journal of the American College of Emergency Physicians Open anticoagulant reversal factor Xa inhibitor gastrointestinal hemorrhage |
| title | Definition of factor Xa inhibitor–related, life‐threatening gastrointestinal bleeding and guidance on when to use reversal therapy: A Delphi panel |
| title_full | Definition of factor Xa inhibitor–related, life‐threatening gastrointestinal bleeding and guidance on when to use reversal therapy: A Delphi panel |
| title_fullStr | Definition of factor Xa inhibitor–related, life‐threatening gastrointestinal bleeding and guidance on when to use reversal therapy: A Delphi panel |
| title_full_unstemmed | Definition of factor Xa inhibitor–related, life‐threatening gastrointestinal bleeding and guidance on when to use reversal therapy: A Delphi panel |
| title_short | Definition of factor Xa inhibitor–related, life‐threatening gastrointestinal bleeding and guidance on when to use reversal therapy: A Delphi panel |
| title_sort | definition of factor xa inhibitor related life threatening gastrointestinal bleeding and guidance on when to use reversal therapy a delphi panel |
| topic | anticoagulant reversal factor Xa inhibitor gastrointestinal hemorrhage |
| url | https://doi.org/10.1002/emp2.13043 |
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