Major bleeding with old and novel oral anticoagulants: How to manage it. Focus on reversal agents

Fusco, Stefania Angela Di; Lucà, Fabiana; Benvenuto, Manuela; Iorio, Annamaria; Fiscella, Damiana; D’Ascenzo, Fabrizio; Madeo, Andrea; Colivicchi, Furio; Lenarda, Andrea Di; Gulizia, Michele Massimo

doi:10.1016/j.ijcard.2018.05.060

Cited by 14 publications

(13 citation statements)

References 44 publications

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“…There is some evidence that prothrombin complex concentrate is effective at reversing the anticoagulant effects of factor Xa inhibitors. 33 The use of prothrombin complex concentrate is therefore only recommended in cases where there are no specific antidotes available and in the circumstances of life-threatening bleeding that cannot be managed with supportive measures. 14,33…”

Section: Discussionmentioning

confidence: 99%

Management of epistaxis in patients on novel oral anticoagulation therapy

Bari

Riffat

2020

J. Laryngol. Otol.

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BackgroundIndividuals on anticoagulation therapy are at increased risk of bleeding, including epistaxis. There is a lack of available reversal agents for novel oral anticoagulation therapy.ObjectiveThis paper reviews the current literature on epistaxis in the context of novel oral anticoagulation use, in order to recommend guidelines on management.MethodA comprehensive search of published literature was conducted to identify all relevant articles published up to April 2019.ResultsPatients on oral anticoagulation therapy are over-represented in individuals with epistaxis. Those on novel oral anticoagulation therapy were more likely to relapse compared to patients on classic oral anticoagulants or non-anticoagulated patients. Idarucizumab is an effective antidote for bleeding associated with dabigatran use. Recommendations for epistaxis management in patients on novel oral anticoagulation therapy are outlined.ConclusionClinicians need to be aware of the potential severity of epistaxis and the increased likelihood of recurrence. High-quality studies are required to determine the efficacy and safety of andexanet alfa and ciraparantag, as well as non-specific reversal agents.

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Section: Discussionmentioning

confidence: 99%

Management of epistaxis in patients on novel oral anticoagulation therapy

Bari

Riffat

2020

J. Laryngol. Otol.

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“…Furthermore, the crucial point in DOACs-associated emergencies is to be able to identify the presence of an anticoagulant agent, and to be able to predict its remaining anticoagulant activity. 17 It is also important to emphasize that patients on long-term DOAC therapy with severe bleeding can present with coagulopathy not induced by DOACs. Such coagulopathy might also be detected with laboratory assays.…”

Section: Idarucizumabmentioning

confidence: 99%

ROTEM Testing for Direct Oral Anticoagulants

Korpallová

Samoš

Bolek

et al. 2021

Semin Thromb Hemost

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Direct oral anticoagulants (DOACs) are increasingly used worldwide for the prevention of stroke in patients with atrial fibrillation and to prevent or treat venous thromboembolism. In situations such as serious bleeding, the need for urgent surgery/intervention or the management of a thromboembolic event, the laboratory measurement of DOACs levels or anticoagulant activity may be required. Rotational thromboelastometry (ROTEM) is a viscoelastic hemostatic assay (VHA) which has been used in emergencies (trauma and obstetrics), and surgical procedures (cardiac surgery and liver transplants), but experience with this assay in DOACs-treated patients is still limited. This article reviews the use of ROTEM in the setting of DOACs therapy, focusing on DOACs-associated bleeding and the use of this VHA for the management of reversal strategies for DOACs-associated anticoagulation.

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“…An ABO compatibility test should be undertaken, which can take a long time to defrost. In addition, a high infusion volume (>1.5L) and a protracted infusion time could be needed to increase coagulation factor concentration [34]…”

Section: Alternative Agents In the Treatment Of Gihmentioning

confidence: 99%

Management of Patients with Gastrointestinal Hemorrhage While Receiving Warfarin: Vitamin K, Prothrombin Complex Concentrates and Others

Karcıoğlu¹

2020

JAICM

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Introduction: Prothrombin complex concentrates (PCC) has long been used to reverse vitamin K antagonists (VKA) induced coagulopathy rapidly and safely. This article is a review and critical analysis of the most recent literature to analyse treatment with PCC, focusing on gastrointestinal hemorrhage (GIH) in patients on warfarin.Methods: Currently available literature on the use of PCC in GIH was identified by searches of electronic database. Utilization of PCC was addressed in the literature data found by searches of databases. The indications, efficacy and outcomes associated with the use of the product (three vs four-factors) were reviewed in the articles.Results: In general, studies point out promising results with respect to PCC use to overcome the VKA-related coagulopathy in GIH. Comparison of different aspects of treatment with PCC and vitamin K, Fresh frozen plasma (FFP) are discussed. PCC is the treatment of choice for normalization of prothtombin time and INR values and resuscitation in emergency setting in patients diagnosed with GIH. Dosing principles are also mentioned. Conclusion:PCC is the front-line agent to reverse the VKA-related coagulopathy. PCC should be considered for resuscitation in emergency and intensive care in case of severe hemodynamic compromise in GIH associated with high INR values.

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Major bleeding with old and novel oral anticoagulants: How to manage it. Focus on reversal agents

Cited by 14 publications

References 44 publications

Management of epistaxis in patients on novel oral anticoagulation therapy

Management of epistaxis in patients on novel oral anticoagulation therapy

ROTEM Testing for Direct Oral Anticoagulants

Management of Patients with Gastrointestinal Hemorrhage While Receiving Warfarin: Vitamin K, Prothrombin Complex Concentrates and Others

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