title: Management of hemorrhage with the target-specific oral anticoagulants.
abstract: The target-specific oral anticoagulants have recently been introduced as alternatives to warfarin for both prophylactic and therapeutic indications. Although their efficacy and side-effect profiles have been favorable, there is significant concern about management of hemorrhage with these agents as there is no direct reversal agent available. It is important for clinicians to be aware of these agents and the issues that surround them. Most of the management of hemorrhage is based on expert opinion and case reviews. Given the potentially catastrophic consequences of acute hemorrhage while patients are on anticoagulation, specific treatments are needed. Some methods that have been described include activated charcoal, hemodialysis, prohemostatic agents, and transfusions. Target-specific therapies have been shown to be effective in early studies in animal models; however, the effects in humans are still under investigation. More investigation is needed on the management of bleeding complications from target-specific oral anticoagulants.
authors.affiliation: Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO. pluymm@umkc.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Pluym
authors.forename: Gregory
authors.initials: G
authors.lastname: Howell
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D001562:Benzimidazoles / Q000009:adverse effects / Q000493:pharmacokinetics; D001803:Blood Transfusion / Q000379:methods; D002606:Charcoal / Q000627:therapeutic use; D000069604:Dabigatran; D016903:Drug Monitoring; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy*; D006801:Humans; D009025:Morpholines / Q000009:adverse effects / Q000493:pharmacokinetics; D011720:Pyrazoles / Q000009:adverse effects / Q000493:pharmacokinetics; D011728:Pyridones / Q000009:adverse effects / Q000493:pharmacokinetics; D006435:Renal Dialysis / Q000379:methods; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects / Q000493:pharmacokinetics; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; D002606:Charcoal; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran