title: Preventive strategies against bleeding due to nonvitamin K antagonist oral anticoagulants.
abstract: Dabigatran etexilate (DE), rivaroxaban, and apixaban are nonvitamin K antagonist oral anticoagulants (NOACs) that have been compared in clinical trials with existing anticoagulants (warfarin and enoxaparin) in several indications for the prevention and treatment of thrombotic events. All NOACs presented bleeding events despite a careful selection and control of patients. Compared with warfarin, NOACs had a decreased risk of intracranial hemorrhage, and apixaban and DE (110 mg BID) had a decreased risk of major bleeding from any site. Rivaroxaban and DE showed an increased risk of major gastrointestinal bleeding compared with warfarin. Developing strategies to minimize the risk of bleeding is essential, as major bleedings are reported in clinical practice and specific antidotes are currently not available. In this paper, the following preventive approaches are reviewed: improvement of appropriate prescription, identification of modifiable bleeding risk factors, tailoring NOAC's dose, dealing with a missed dose as well as adhesion to switching, bridging and anesthetic procedures.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lessire
authors.affiliation: Department of Anesthesiology, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium ; Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), University of Namur, 5000 Namur, Belgium.
authors.forename: Lessire
authors.initials: L
authors.lastname: Sarah
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Dincq
authors.affiliation: Department of Anesthesiology, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium.
authors.forename: Dincq
authors.initials: D
authors.lastname: Anne-Sophie
authors.forename: Jonathan
authors.initials: J
authors.lastname: Douxfils
authors.affiliation: Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), University of Namur, 5000 Namur, Belgium.
authors.forename: Douxfils
authors.initials: D
authors.lastname: Jonathan
authors.forename: Bérangère
authors.initials: B
authors.lastname: Devalet
authors.affiliation: Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), University of Namur, 5000 Namur, Belgium ; Department of Hematology, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium.
authors.forename: Devalet
authors.initials: D
authors.lastname: Bérangère
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Nicolas
authors.affiliation: Department of Internal Medicine, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jean-Baptiste
authors.forename: Anne
authors.initials: A
authors.lastname: Spinewine
authors.affiliation: Department of Pharmacy, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium ; Université Catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, 1200 Brussels, Belgium.
authors.forename: Spinewine
authors.initials: S
authors.lastname: Anne
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Larock
authors.affiliation: Department of Pharmacy, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium ; Université Catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, 1200 Brussels, Belgium.
authors.forename: Larock
authors.initials: L
authors.lastname: Anne-Sophie
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Dogné
authors.affiliation: Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), University of Namur, 5000 Namur, Belgium.
authors.forename: Dogné
authors.initials: D
authors.lastname: Jean-Michel
authors.forename: Maximilien
authors.initials: M
authors.lastname: Gourdin
authors.affiliation: Department of Anesthesiology, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium.
authors.forename: Gourdin
authors.initials: G
authors.lastname: Maximilien
authors.forename: François
authors.initials: F
authors.lastname: Mullier
authors.affiliation: Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), University of Namur, 5000 Namur, Belgium ; Department of Pharmacy, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium ; Hematology Laboratory, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium.
authors.forename: Mullier
authors.initials: M
authors.lastname: François
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002986:Clinical Trials as Topic; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000517:prevention & control*; D012307:Risk Factors; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K