Major bleeding with old and novel oral anticoagulants: How to

Int. J. Cardiol. · Oct 2018

Review

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

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. ⋯ 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.

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- Stefania Angela Di Fusco, Fabiana Lucà, Manuela Benvenuto, Annamaria Iorio, Damiana Fiscella, Fabrizio D'Ascenzo, Andrea Madeo, Furio Colivicchi, Andrea Di Lenarda, and Michele Massimo Gulizia.
- Cardiology Unit, San Filippo Neri Hospital, Rome, Italy. Electronic address: stefaniaa.difusco@aslroma1.it.
- Int. J. Cardiol. 2018 Oct 1; 268: 75-79.
AbstractEven 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.Copyright © 2018 Elsevier B.V. All rights reserved.

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

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