Is bridging necessary?
Bridging is the interruption of the intake of medication for a short period of time. This may be necessary with anticoagulants before operations. Small operations, such as dental surgery, can be performed without bridging.
Larger operations, however, are associated with a high risk of bleeding and therefore cannot be carried out while anticoagulant medication is being taken. In this case the intake is interrupted for a few days. As this carries a high risk of complications, the necessity of the operation must be strictly controlled. In emergency operations, the urgency of the operation must be weighed against the risk of bleeding.
Is there an antidote?
While the new oral anticoagulants, which include Xarelto®, have many advantages over other anticoagulants, there is also a major disadvantage. There is no antidote for Xarelto®. Even filtering out the drug through dialysis is not promising due to its chemical properties.
In the event of severe side effects and bleeding, patients must therefore be treated symptomatically. The bleeding can be treated by compression and local or systemic haemostatic drugs as well as blood preservatives, and in the case of allergic reactions the classic antihistamines and cortisol should be used. Since Xarelto® has a relatively short half-life, if not taken, the active ingredient disappears from the blood after a few hours and normal blood clotting resumes.
In the event of an acute overdose, activated carbon can be used to bind medication present in the stomach, as long as this is noticed in time. This is a measure which can be used, for example, when children have taken their parents’ or grandparents’ medication.