Bleeding Risk, Management and Outcome in Patients Receiving Non-VKA Oral Anticoagulants (NOACs).
Modern direct-acting anticoagulants are rapidly replacing vitamin K antagonists (VKA) in the management of millions of patients worldwide who require anticoagulation. These drugs include agents that inhibit activated factor X (FXa) (such as apixaban and rivaroxaban) or thrombin (such as dabigatran), and are collectively known today as non-VKA oral anticoagulants (NOACs). Since bleeding is the most common and most dangerous side effect of long-term anticoagulation, and because NOACs have very different mechanisms of action and pharmacokinetics compared with VKA, physicians are naturally concerned about the lack of experience regarding frequency, management and outcome of NOAC-associated bleeding in daily care. This review appraises trial and registry (or "real-world") data pertaining to bleeding complications in patients taking NOACs and VKA and provides practical recommendations for the management of acute bleeding situations.
Division of Angiology, Center for Vascular Medicine and Department of Medicine III, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
Sebastian
S
Werth
Tomás
T
Breslin
Fionnuala
F
NiAinle
Jan
J
Beyer-Westendorf
D000991:Antithrombins / Q000494:pharmacology; D002986:Clinical Trials as Topic; D000069604:Dabigatran / Q000494:pharmacology*; D065427:Factor Xa Inhibitors / Q000494:pharmacology; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D017063:Outcome Assessment, Health Care; D011720:Pyrazoles / Q000494:pharmacology*; D011728:Pyridones / Q000494:pharmacology*; D018570:Risk Assessment; D000069552:Rivaroxaban / Q000494:pharmacology*; D013923:Thromboembolism / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
D000991:Antithrombins; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran