title: Bleeding management in patients with new oral anticoagulants.
abstract: New oral anticoagulants (NOACs) have been developed in recent years and are increasingly used in clinical practice. Dabigatran is a direct thrombin (factor II) inhibitor while rivaroxaban, apixaban and edoxaban are direct inhibitors of factor Xa. The European Medicines Agency (EMA) currently approves these NOACs for different clinical uses. NOACs do not require routine monitoring of coagulation although an assessment of anticoagulation activity in these patients may be required in different conditions. NOACs show a similar or lower incidence of bleeding compared with conventional therapies in phase III trials. In case of bleeding, non-specific reversal strategies are available while specific reversal agents are the subject of ongoing trials. The role of this review is to summarize the current knowledge on NOCAs focusing on bleeding management in the perioperative period.
authors.affiliation: Unit of Anesthesia and Intensive Care, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy - servillo@unina.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Vargas
authors.forename: Annachiara
authors.initials: A
authors.lastname: Marra
authors.forename: Antonietta
authors.initials: A
authors.lastname: Perrone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Servillo
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D017326:Clinical Trials, Phase III as Topic; D000069604:Dabigatran / Q000008:administration & dosage / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced / Q000628:therapy*; D006801:Humans; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects; D013844:Thiazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban