• Vicente Vicente, Alfonso Martín, Ramón Lecumberri, Blanca Coll-Vinent, Coral Suero, José Ramón González-Porras, Pascual Marco, José Mateo, Vanesa Roldán, Stéphane Soulard, Carlos Crespo, Míriam Camats, and Grupo DECOVER.
• Servicio de Hematología y de Oncología Médica, Hospital Universitario Morales Meseguer, Murcia, España.
• Emergencias. 2017 Feb 1; 29 (1): 18-26.

ObjectivesTo evaluate the level of agreement between hematologists and emergency medicine physicians regarding the best clinical practices for managing bleeding and anticoagulant reversal.Material And MethodsNationwide Spanish multicenter Delphi method study with a panel of experts on anticoagulation and the management of bleeding. Two survey rounds were carried out between April and September 2015. Consensus was reached when more than 75% of the panelists scored items in the same tertile.ResultsFifteen hematologists and 17 emergency medicine specialists from 14 Spanish autonomous communities participated. Consensus was reached on the use of both hemodialysis and an activated prothrombin complex concentrate (PCC) to antagonize significant/major bleeding in patients taking dabigatran. Use of an activated PCC was considered sufficient for patients on rivaroxaban or apixaban. The panel did not consider any PCC to be both effective and safe. Tests for activated partial thromboplastin, thrombin, diluted thrombin, and ecarin clotting times were considered useful in patients treated with dabigatran. A specific anti-Xa activity assay was suggested for patients who developed bleeds while treated with rivaroxaban or apixaban. Specific antidotes for direct-acting oral anticoagulants would be useful when severe bleeding occurs according to 97% of the panelists. Such antidotes would substantially change current treatment algorithms.ConclusionThe points of consensus were generally in line with clinical practice guidelines, but the Delphi process revealed that there are aspects of the clinical management of bleeding that require unified criteria. The need for specific antidotes for direct-acting oral anticoagulants was emphasized.

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