title: Management of Bleeding Associated with New Oral Anticoagulants.
abstract: In the last few years, a great improvement in the management of clinical thromboembolism has been made thanks to the availability of novel oral anticoagulants. These drugs, which act by directly inhibiting thrombin (dabigatran) or activated factor X (apixaban, rivaroxaban, and edoxaban), offer several practical advantages over the traditional vitamin K antagonists (VKA), such as a more predictable anticoagulant effect with no need for routine coagulation monitoring and a limited drug and food interaction. Several phase III clinical trials have now been completed, overall demonstrating that non-VKA oral antagonists (NOACs) are at least as efficacious and safe as VKA in the prevention and treatment of thromboembolism. Nevertheless, patients receiving NOACs represent a new challenge because no antidotes are currently available for these drugs. In this review, after a description of the main pharmacologic characteristics and the main results of the clinical trials of NOACs, we will focus on the management of bleeding associated with these anticoagulant agents. A treatment algorithm of NOACs-associated bleeding is finally provided, with the aim of helping physicians in their daily care activity.
authors.affiliation: Department of Hematology and Transfusion Medicine, C. Poma Hospital, Mantova, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Franchini
authors.affiliation: Department of Hematology and Transfusion Medicine, C. Poma Hospital, Mantova, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bonfanti
authors.affiliation: IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000284:Administration, Oral; D000465:Algorithms; D017326:Clinical Trials, Phase III as Topic; D065427:Factor Xa Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D013923:Thromboembolism / Q000188:drug therapy*
chemical_list: D065427:Factor Xa Inhibitors