Major bleeding with old and novel oral anticoagulants: How to manage it. Focus on general measures. (1st October 2018)

• Record Type: Journal Article
• Authors: Di Fusco, Stefania Angela; Lucà, Fabiana; Benvenuto, Manuela; Iorio, Annamaria; Fiscella, Damiana; D'Ascenzo, Fabrizio; Madeo, Andrea; Colivicchi, Furio; Di Lenarda, Andrea; Gulizia, Michele Massimo
• Is Part Of: International journal of cardiology. Volume 268(2018)
• Page Start: 80
• Page End: 84
• Publication Date: 2018-10-01
• Subjects: AF atrial fibrillation -- ACT activated clotting time -- aPTT activated partial thromboplastin time -- b.i.d. twice daily -- dTT diluted thrombin time -- ECT ecarin clotting time -- FFP fresh frozen plasma -- FXa factor X activated -- INR International Normalized Ratio -- NOAC non-vitamin K antagonist oral anticoagulant -- N.A. not applicable -- o.d. once daily -- PT prothrombin time -- RBC red blood cells -- ULN upper limit of the normal range. -- VKA vitamin K antagonist -- VTE venous thromboembolism; Major bleeding -- Non-vitamin K antagonist oral anticoagulants -- Vitamin-K antagonists -- Warfarin; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.05.061
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: In the last decade, the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) in clinical practice has changed the therapeutic landscape in the prevention of thromboembolic events. Although NOACs compared to vitamin K antagonists (VKAs) have demonstrated a similar or slightly lower rate of major bleeding and a lower rate of intracranial or fatal bleeding, hemorrhaging still represents the main adverse effect of anticoagulant treatment. This review reports data on the rates of major bleeding with old and new oral anticoagulants. It analyses laboratory tests that can be used to assess the intensity of anticoagulation in patients treated with oral anticoagulants and discusses general measures to implement in managing major bleeding. Graphical abstract: Highlights: With old and new oral anticoagulants the global hemorrhagic risk is non-negligible. In cases of serious bleeding the presence of anticoagulation effect should be assessed. The amount of anticoagulant activity may guide reversal strategies. Major bleedings should initially be treated with hemodynamic-supporting measures. When appropriate, local mechanical hemostatic interventions should be employed.