title: Management of bleeding with oral anticoagulants in patients with atrial fibrillation.
abstract: Fear of bleeding is a common barrier to the use of anticoagulants. Warfarin has been the only oral anticoagulant for more than 60 years and warfarin-related bleeding is reported to be the most common drug-related cause of emergency hospitalization in elderly Americans. Non-vitamin K oral antagonists were introduced five years ago and compared with warfarin are associated with lower risk of intracranial bleeding, and similar or lower case fatality after major bleeding. Despite their superior safety profile, serious bleeding can occur. Most bleeding can be managed with holding the drug, local measures to control the bleeding and transfusion support as required because the NOACs have a relatively short half life and their anticoagulant effect rapidly dissipates. In patients with ongoing bleeding despite supportive measures and in those with life-threatening bleeding, consideration may be given to the use of general hemostatic agents. Experimental and animal evidence suggests that 3 and 4 factor prothrombin complex concentrates can improve hemostasis in the presence of a NOAC and this is reinforced by anecdotal evidence in humans. Specific antidotes are currently in phase 3 trials and could become available in the near future.
authors.forename: J
authors.initials: J
authors.lastname: Bosch
authors.affiliation: John W Eikelboom, Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton St. E., Hamilton, ON, Canada L8L 2X2, Tel. 905-527-4322 ext 40323, Fax 905-297-3785, E-mail: eikelbj@mcmaster.ca.
authors.forename: J W
authors.initials: JW
authors.lastname: Eikelboom
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000009:adverse effects; D004347:Drug Interactions; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D006490:Hemostatics / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D006490:Hemostatics; C025667:prothrombin complex concentrates
keywords: Bleeding; anticoagulation; atrial fibrillation