title: Re-Initiation of Dabigatran and Direct Factor Xa Antagonists After a Major Bleed.
abstract: Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence.
authors: Departments of Neurology and Surgery and Perioperative Care, Seton Dell Medical School Stroke Institute, Austin, TX. Electronic address: TMilling@seton.org.
authors: Truman J
authors: TJ
authors: Milling
authors: Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System, Manhasset, NY.
authors: Alex C
authors: AC
authors: Spyropoulos
mesh_terms: D000991:Antithrombins / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D000069604:Dabigatran / Q000627:therapeutic use; D065427:Factor Xa Inhibitors / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006470:Hemorrhage; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D012008:Recurrence; D018570:Risk Assessment; D000069552:Rivaroxaban / Q000627:therapeutic use; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000991:Antithrombins; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Direct-acting oral anticoagulants; Gastrointestinal bleeding; Intracranial hemorrhage; Major hemorrhage; Restart oral anticoagulants; Warfarin