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Avoid anticoagulants.
- Current use of anticoagulant with INR >1.7 or PT >15 seconds
• In patients without recent use of oral anticoagulants or heparin, treatment with rtPA can be initiated before availability of coagulation study results but should be discontinued if INR is >1.7 or PT is elevated by local laboratory standards.
Do not administer anticoagulants or antiplatelet treatment for 24 hours after administration of rtPA, typically until a follow-up CT scan at 24 hours shows no intracranial hemorrhage.
• Taking an oral anticoagulant regardless of INR،the dialysis circuit, so anticoagulants, heparin or citrates, are typi- cally required, which may present problems for many patients in the surgical ICU.
With increas- ing resolution of CT scans, more incidental subsegmental emboli are being found, but it appears that anticoagulation is not indi- cated for these patients.
Patients with larger pulmonary embo- lisms should receive systemic anticoagulation with subsequent conversion to oral agents.
Massive Transfusion Strategies and Anticoagulation Reversal
PCC is growing in popularity as a reversal agent for patients taking anticoagulants, especially the so-called novel anticoagulants.
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