title: [Direct oral anticoagulation and gastrointestinal bleeding: Interventional therapy management].
abstract: BACKGROUND
  More and more patients are being treated with direct oral anticoagulants (DOAC). Under treatment with DOACs gastrointestinal bleeding appears to occur more frequently, particularly in the lower gastrointestinal tract, compared to treatment with vitamin K antagonists (e.g. warfarin).
  
  
  OBJECTIVE
  A possible approach should now be elaborated in a joint effort by gastroenterologists and cardiologists.
  
  
  METHODS
  A selective literatue search was carried out and own experiences were also included.
  
  
  RESULTS
  The decision to perform procoagulant therapy by slowly injecting 30-50 IU prothrombin complex concentrate (PPSB) per kg body weight intravenously depends on various factors and should be assessed critically. Specific antidotes are awaiting approval. After a bleeding episode potentially controllable and reversible triggers must be excluded (e.g. drug interactions and renal impairment). The risk of recurrent bleeding and the risk of thromboembolic events have to be weighed against each other before deciding to readminister an anticoagulant and its form. Dose reduction and changing to apixaban (in reduced dosage) are options for risk reduction and vitamin K antagonists can also be considered.
  
  
  CONCLUSIONS
  It is still unclear what role specific antidotes will play.
authors.affiliation: Medizinische Klinik III, Gastroenterologie, Hepatologie, Infektiologie, Rheumatologie, Internistische Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland. georg.braun@klinikum-augsburg.de.
authors.forename: G
authors.initials: G
authors.lastname: Braun
authors.affiliation: Medizinische Klinik III, Gastroenterologie, Hepatologie, Infektiologie, Rheumatologie, Internistische Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Messmann
authors.affiliation: Innere Medizin, Diakonie Klinikum Ev. Jung-Stilling-Krankenhaus, Wichernstr. 40, 57074, Siegen, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Labenz
authors.affiliation: Medizinische Klinik II, Kardiologie, Angiologie, Internistische Intensivmedizin, St. Marien-Krankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Buerke
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods*; D057915:Drug Substitution; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D011516:Prothrombin / Q000008:administration & dosage* / Q000009:adverse effects; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use; D011728:Pyridones / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D013923:Thromboembolism / Q000139:chemically induced / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C522181:apixaban; D011516:Prothrombin
keywords: Antidotes; DOAC; Gastrointestinal bleeding; Procoagulant therapy; Risk evaluation