All right, so welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas, and we're going to talk about anticoagulation reversal.

We got all your big hits today, the warfriends, the noax, the anti-platelets, when we should do TXA, and all the nuances in between.

I'm excited for this one, Josh, so let's get straight into it. Considerations when we should do TXA and all the nuances in between. I'm excited for this one, Josh, so let's get straight into it.

Considerations when we're approaching anti-quagulation.

I have to say this is something I am terrified about with cases

or something I probably miss because I'm moving on to other things.

So tell me about what's important to understand about the quaglopathy

in the patient in front of me and how I factor in when they got their dose, what's important to understand about the quaglopsy in the patient in front

of me and how I factor in when they got their dose, what's the pharmacology, et cetera,

et cetera.

Yeah, so I think it's just important to consider the big picture here.

So oftentimes patients will present with, for example, like a GI hemorrhage and we certainly

want to reverse their anti-collegulation.

But before we jump in and do that, you want to think about several things. First of all, why were they anti-coagulated in the first place? So,

for example, if it's just atrial fibrillation, that's fine, you can aggressively reverse it.

If they have a mechanical mitral valve, you know, you might want to be a little bit more conservative.

What drugs are they on? When's the last time they got those medications. So what is their likely drug level? Also, what's their global

coagulopathic status? So is this someone who's on like three anti-platelet drugs, thromacetopinic

with an iron rf two, so all the different pieces? We just had this case, someone who's with

life-threatening bleeding, but also has a mechanical mitrov valve. So talk to me about the nuances

about how to factor that into your approach. You know, I think if the patient truly has a life-threatening bleed and you're genuinely

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