RVSL – Medical Reversal Guide for Anticoagulants

RVSL (Reversal) provides a comprehensive, evidence-based review of old and novel anticoagulants and anti-platelet agents with pharmacokinetic and pharmacodynamics profiles, monitoring strategies, management plans for reversal, and references. Management strategies for acquired bleeding disorders are also reviewed.

The app aims to be a quick, easily accessible, and efficient foundation of reversal strategies for life threatening bleeding or patients requiring surgery who are on an anticoagulant, anti-platelet agent, or who have an acquired bleeding disorder. This app is written and intended for practicing clinicians treating life threatening bleeding such as surgeons, emergency physicians, intensivists, anesthesiologists, nurses, pharmacists, PAs and NPs; for resident physician trainees; and for medical students. Of note, management strategies are also presented for mild and moderate bleeding scenarios as well.

The app is designed to include the following functionality to be all-inclusive for the user and optimize efficient decision-making: Search; Calculator; Highlighting; Zoom; ability to create Notes; KCENTRA and Feiba Dosing; overview of Lab Values; overview of Reversal Agents for Anticoagulants and Anti-platelet Agents; and Administration Rates of parenteral drugs. The notes functionality can also be used to add unique information specific to your practice and hospital such as phone numbers for various departments, drug availability, new references and sources of information, etc.

Anticoagulants and anti-platelet agents reviewed include: Warfarin (Coumadin®); Unfractionated Heparin; Enoxaparin (Lovenox®); dalteparin (Fragmin®); Argatroban; bivalrudin (Angiomax®); desirudin (Iprivask®); Dabigatran (Pradaxa®); Fondaparinux (Arixtra®); Apixaban (Eliquis®); edoxaban (Savaysa®); rivaroxaban (Xarelto®); Alteplase (Activase®); reteplase (Retavase®); tenectaplase (TNKase®); Abciximab (ReoPro®); eptifibatide (Integrilin®); tirofiban (Aggrastat®); Aspirin; clopidogrel (Plavix®); dipyridamole (Persantine®); prasugrel (Effient®); and ticagrelor (Brilinta®).

Acquired bleeding disorders reviewed include: Spontaneous Intracerebral hemorrhage not on anticoagulant/antiplatelet; Exsanguination; Hepatic Patients; Vitamin K Deficiency; Disseminated intravascular coagulation (DIC); Uremic Patients; Acquired Hemophilia; and Acquired Von Willibrand’s Disease.

The information provided comes from numerous peer-reviewed sources, book chapters, and University Guidelines that are cited in our references section. The app’s content and format are the result of collaboration between emergency medicine pharmacists, emergency medicine physicians, and surgeons.

SurgeonIDEAS, LLC (www.surgeonideas.com) is a company that creates medical education material for clinicians and we are interested in feedback. We would be grateful for guidance on improving the tool. Please visit our website and offer any comments you may have and tell us how you are using your notes section! You can expect the app to be updated regularly with literature reviews to ensure up-to-date, accurate information is provided.