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

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 ra...

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Bibliographic Details
Published in:International journal of cardiology 2018-10, Vol.268, p.80-84
Main 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
Format: Article
Language:English
Subjects:
Administration, Oral
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Disease Management
Hemorrhage - chemically induced
Hemorrhage - diagnosis
Hemorrhage - therapy
Hemostatics - pharmacology
Hemostatics - therapeutic use
Humans
Major bleeding
Non-vitamin K antagonist oral anticoagulants
Vitamin K - antagonists & inhibitors
Vitamin-K antagonists
Warfarin
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Summary: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. [Display omitted] •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.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2018.05.061