title: Acute management of bleeding in patients on novel oral anticoagulants.
abstract: Novel oral anticoagulants that directly inhibit thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban) are currently available for prevention of venous thromboembolism (VTE) after orthopaedic surgery, treatment of acute VTE, and prevention of arterial thromboembolism in non-valvular atrial fibrillation. These agents offer advantages over VKAs, including rapid onset, shorter half-lives, fewer drug interactions, and lack of need for routine monitoring. However, there are no established agents to reverse their anticoagulant effect. We review the risk of bleeding with the novel oral anticoagulants and the limitations of conventional coagulation assays for measuring anticoagulant effect. We provide an approach to the management of patients with bleeding complications with evidence for various interventions for reversal, where available.
authors.affiliation: Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Siegal
authors.forename: Mark A
authors.initials: MA
authors.lastname: Crowther
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D001780:Blood Coagulation Tests; D000069604:Dabigatran; D004359:Drug Therapy, Combination; D065427:Factor Xa Inhibitors; D006470:Hemorrhage / Q000517:prevention & control*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D009025:Morpholines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D010949:Plasma; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications; D012307:Risk Factors; D000069552:Rivaroxaban; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D006490:Hemostatics; D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran