title: How I treat target-specific oral anticoagulant-associated bleeding.
abstract: Target-specific oral anticoagulants (TSOACs) that directly inhibit thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban) are effective and safe alternatives to vitamin K antagonists (VKAs) and low-molecular-weight heparin (LMWH). Although these agents have practical advantages compared with VKAs and LMWH, there are no antidotes that reverse their anticoagulant effect. Clinical evidence for the efficacy of nonspecific therapies that promote formation of fibrin (prothrombin complex concentrate [PCC], activated PCC [aPCC], and recombinant factor VIIa) in the setting of TSOAC-associated bleeding is lacking, and these prohemostatic products are associated with a risk of thrombosis. In the absence of specific antidotes, addition of PCC or aPCC to maximum supportive therapy may be reasonable for patients with severe or life-threatening TSOAC-associated bleeding. Targeted antidotes for these agents are in development.
authors.affiliation: Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada; and.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Siegal
authors.forename: David A
authors.initials: DA
authors.lastname: Garcia
authors.forename: Mark A
authors.initials: MA
authors.lastname: Crowther
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D000991:Antithrombins / Q000009:adverse effects; D001562:Benzimidazoles / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D000069604:Dabigatran; D016903:Drug Monitoring / Q000379:methods; D015942:Factor VIIa / Q000008:administration & dosage*; D006470:Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy*; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D009025:Morpholines / Q000009:adverse effects*; D011720:Pyrazoles / Q000009:adverse effects; D011728:Pyridones / Q000009:adverse effects; D011994:Recombinant Proteins / Q000008:administration & dosage; D006435:Renal Dialysis; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects*; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D000991:Antithrombins; D001562:Benzimidazoles; D001779:Blood Coagulation Factors; D006490:Hemostatics; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D011994:Recombinant Proteins; D013876:Thiophenes; D015091:beta-Alanine; C025667:prothrombin complex concentrates; C522181:apixaban; D000069552:Rivaroxaban; C103587:recombinant FVIIa; D015942:Factor VIIa; D000069604:Dabigatran