Managing Anticoagulation Prior to Emergency Surgery
A 76-year-old male presents to the Emergency Department with sudden onset of intense (10/10) sharp chest pain radiating to the neck and shoulders beginning approximately 45 minutes ago and associated with diaphoresis and dyspnea. He has a past medical history significant for hypertension, heart failure with preserved ejection fraction, hyperlipidemia, and atrial fibrillation. The outpatient medications include amlodipine 10mg daily, atorvastatin 40mg daily, lisinopril 40mg daily and rivaroxaban 20mg daily, all of which he last took about 4 hours ago.
A CT scan of the chest confirms a Type A aortic dissection beginning superior to the coronary arteries and extending to the level of the renal arteries. After reviewing these findings and discussing the management options with the patient, the decision is made to proceed urgently to the operating room for definitive management.
In addition to supportive measures, which of the following therapeutic interventions may help reduce his risk of bleeding?