Major bleeding with old and novel oral anticoagulants: How to manage it. Focus on reversal agents. (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: 75
• Page End: 79
• Publication Date: 2018-10-01
• Subjects: FFP Fresh Frozen Plasma -- FXa factor X activated -- INR International Normalized Ratio -- NOAC non-vitamin K antagonist oral anticoagulant -- PCC prothrombin complex concentrate -- PCCa prothrombin complex concentrate activated -- RBC red blood cells -- rFVIIa recombinant factor VII activated -- VKA vitamin K antagonist; Anticoagulant antidotes -- Major bleeding -- Non-vitamin K antagonist oral anticoagulants -- Reversal agents -- Vitamin-K antagonists -- Warfarin; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.05.060
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Even though vitamin K antagonists (VKAs) have been employed for >50 years, there is still some uncertainty about the best strategy to reverse anticoagulation due to VKAs in cases of major bleeding. Furthermore, there is also scarce evidence about the most appropriate way to treat serious bleeding associated with non-vitamin K antagonist oral anticoagulants. This review analyses the main advantages and disadvantages of the various forthcoming therapeutic options to restore a normal coagulation status in anticoagulated patients with ongoing serious bleeding. It discusses the role of fresh frozen plasma, prothrombin complex concentrates and recombinant factor VII activated. Moreover, we report updated evidence on antidotes currently available or in development. Finally, this article proposes a comprehensive algorithm that summarizes major bleeding management during treatment with oral anticoagulants. Graphical abstract: Algorithm for the management of major bleeding associated with VKAs and NOACs. Highlights: The resort to reversal treatments should be determined by assessing the risk-benefit ratio. In major bleeding, vitamin K is used with more rapid reversal agents such as PCCs. In warfarin patients, PCC dosage is established based on patient weight and INR. PCC is an anticoagulation reversal strategy for patients treated with FXa inhibitors. In dabigatran patients with uncontrolled bleeding idarucizumab may be considered.