Bleeding with Anticoagulants and Treatment of Anticoagulant Overdose

 

Signs and Symptoms

 

The major complication of anticoagulation is haemorrhage.

Potential sites of haemorrhage include the retroperitoneum, urinary tract, gastrointestinal tract and CNS.

Significant abdominal and/or back pain in the absence of overt bleeding may indicate internal haemorrhage.

If a rise in pulse rate or fall in BP occurs, or if there is an unexplained fall in Hb, be aware of the possibility of a “silent” bleed.

 

Definitions of Bleeding due to Anticoagulants :

 

Minor

Other bleeding

Major
  • Intracranial (CT or MRI documented)
  • Retroperitoneal (CT or MRI documented)
  • Intra-ocular (excludes conjunctival)
  • Spontaneous muscle haematoma associated with compartment syndrome
  • Any invasive procedure to stop bleeding eg gastroscopy
  • Active bleeding plus either :

Ř                20 g/L fall in haemoglobin

Ř                BP < 90 mmHg systolic

Ř               Oliguria

Fatal

Death due to haemorrhage

 

Major Bleed

If a major bleed occurs:

1.      Stop the anticoagulant.

2.      Remember that in a patient on both heparin and warfarin both drugs will need to be reversed (see appropriate sections for unfractionated heparin, warfarin, or enoxaparin).

3.      If appropriate, investigate bleeding from the GI or urinary tract to exclude an underlying structural lesion.