[Direct oral anticoagulant associated bleeding].
Direct oral anticoagulants (DOAC) are recommended for stroke prevention in atrial fibrillation and for the treatment of venous thromboembolism. However, they are associated with hemorrhagic complications. Management of DOAC-induced bleeding remains challenging. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. Therapeutic options also include antidotes: idarucizumab, antidote for dabigatran, has been approved for use whereas andexanet alpha, antidote for anti-Xa agents, and aripazine, antidote for all DOAC, are under development. Other options include hemodialysis for the treatment of dabigatran-associated bleeding and administration of oral charcoal if recent DOAC ingestion. DOAC plasma concentration measurement is necessary to guide DOAC reversal. We propose an update on DOAC-associated bleeding, integrating the availability of dabigatran antidote and the critical place of DOAC concentration measurements.
Service d'anesthésie réanimation, fondation ophtalmologique Adolphe-de-Rothschild, 75019 Paris, France; Inserm UMRS 1140, faculté de pharmacie, université Paris Descartes, Paris, France. Electronic address: annegodier@yahoo.fr.
A
A
Godier
Inserm UMRS 1140, faculté de pharmacie, université Paris Descartes, Paris, France; Service de cardiologie, HIA Val-de-Grâce, Paris, France.
A-C
AC
Martin
Service d'anesthesie-réanimation, hôpital Cochin, AP-HP, Paris, France.
N
N
Rosencher
Pôle d'hématologie et de transfusion, hôpital universitaire, université de Lille Nord de France, Lille, France.
S
S
Susen
D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D000931:Antidotes / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications; D002606:Charcoal / Q000627:therapeutic use; D000069604:Dabigatran / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D011516:Prothrombin / Q000008:administration & dosage; D006435:Renal Dialysis; D020521:Stroke / Q000517:prevention & control; D054556:Venous Thromboembolism / Q000188:drug therapy
D000925:Anticoagulants; D000931:Antidotes; D002606:Charcoal; D011516:Prothrombin; D000069604:Dabigatran
AVK; Anticoagulant oral direct; Anticoagulants; Antidote; Bleeding; Direct oral anticoagulant; Hémorragie; Hémostatiques; Reversal