Revue médicale suisse
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Revue médicale suisse · Feb 2014
[Management of major bleeding complications in patients on long-term treatment with oral anticoagulants].
The new direct oral anticoagulants directly targeting thrombin (factor IIa) or factor-Xa, are currently used for the treatment of deep venous thrombosis and pulmonary embolism (rivaroxaban, Xarelto) or for the prevention of systemic embolism in non-valvular atrial fibrillation (rivaroxaban; dabigatran, Pradaxa; Apixaban, Eliquis). Given their ease of use, it is expected that these drugs would be widely used in such long-term indications. Beyond their effectiveness, these treatments remain anticoagulant drugs, potentially responsible for bleeding complications, and specific measures should be defined in case of occurrence of such complications.
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Direct oral anticoagulants, anti-Xa and anti-IIa, are indicated in case of atrial fibrillation or venous thromboembolic disease. Annually, one in ten patients treated by anticoagulants required a scheduled or emergent invasive procedure. Short discontinuation before an invasive procedure may lead to incomplete elimination of the drug especially in case of renal insufficiency or drug-drug interactions. ⋯ Before a procedure with a low bleeding risk, stopping direct anticoagulant 24 hours before the procedure is sufficient. In case of emergent surgery, it is proposed to delay surgery for at least one or two half-lives if possible. Prophylactic use of non-specific procoagulant drug is not recommended.