Characterizing anticoagulation reversal practices in Colombia: Initial insights from a national registry

Background: Anticoagulation reversal is critical in emergency settings for patients experiencing anticoagulant-related bleeding or requiring invasive or surgical procedures. Despite its importance, evidence in Colombia is limited. Methods: RECCANT-AR (Registro Colombiano de Clínicas de Anticoagulación y el Uso de Agentes Reversores) is a multicenter, observational, ambispective study analyzing anticoagulated patients requiring reversal therapy due to bleeding or procedural needs. Data from the first 144 patients across four institutions were analyzed to describe their sociodemographic and clinical profiles. Results: The cohort had a mean age of 66.9 years (SD ± 15.3) and a nearly equal sex distribution. Ethnicity was predominantly Mestizo (67.5%), followed by White (17.5%) and Afrodescendant (13.3%). The most common comorbidities were hypertension (61.8%), previous venous thromboembolism episodes (31.3%), dyslipidemia (30.6%), and diabetes mellitus (21.5%). Warfarin was the predominant anticoagulant (84%), followed by apixaban (4.9%) and dabigatran (4.2%). Bleeding was the primary indication for reversal (92.4%), while surgical needs accounted for 7.6% of cases. The most used reversal agents were vitamin K (75%) and prothrombin complex concentrates (27.1%). Hospitalization was required in 82% of cases, with 55.1% admitted to intensive care. The mortality rate was 7.6%. Conclusion: Our study is the first multicenter characterization of anticoagulated patients requiring reversal therapy in Colombia. Cardiovascular comorbidities were highly prevalent, highlighting their association with hemorrhagic complications. Bleeding was the leading indication for reversal, and warfarin the most used anticoagulant, likely reflecting its higher bleeding risk. The limited availability of direct oral anticoagulant-specific reversal agents remains a challenge. The high hospitalization and mortality rates underscore the high-risk nature of this population, emphasizing the need for improved access to reversal agents and optimized anticoagulation practices. Further research is warranted.