Emergency care of patients receiving non-vitamin K antagonist oral anticoagulants

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, edoxaban) have been introduced in several clinical indications. Although NOACs have a favourable benefit-risk profile and can be used without routine laboratory monitoring, they are associated-as any anticoagulant-with a risk of bleeding. In addition, treatment may need to be interrupted in patients who need surgery or other procedures. The objective of this article, developed by a multidisciplinary panel of experts in thrombosis and haemostasis, is to provide an update on the management of NOAC-treated patients who experience a bleeding episode or require an urgent procedure. Recent advances in the development of targeted reversal agents are expected to help streamline the management of NOAC-treated patients in whom rapid reversal of anticoagulation is required.

Direct oral anticoagulants: first airbag

“…Медиана максимальной степени нейтрализации антикоагулянтного эффекта в течение 4 часов составила 100%. При этом в ситуациях, связанных с проведением экстренного хирургического лечения или неотложной процедуры, общая медиана времени с момента введения первого флакона идаруцизумаба до проведения хирургического лечения составила около 1,5 часов [3]. Следует отметить, что перипроцедурный гемостаз, согласно оценке оперирующего хирурга, был нормальным более чем в 93,4% случаев.…”

Strategy to Minimize the Bleeding Risks in Patients With Atrial Fibrillation Who Receive Combined Antithrombotic Therapy After Percutaneous Coronary Intervention

“…Для всех остальных случаев появляется необходимость нейтрализовать его действие. Особенности строения и фармакокинетики дабигатрана дают возможность включить в алгоритмы неотложной помощи применение гемодиализа, позволяющего извлечь из кровотока этот препарат [17]. Для остальных лекарств единственно возможным путем борьбы с тяжелыми и угрожающими жизни кровотечениями остается введение концентрата факторов свертывания крови.…”

Direct factor Xa inhibitor in the prevention of thromboembolism

“…et al reported a favourable benefit-risk profile for the use of DOACs. However, they are still associated, as are any anticoagulants, with a significant risk of bleeding [22].…”

“…It was suggested by J.W. Eikelboom et al [22] that fresh frozen plasma cannot be used to negate the bleeding effect as large volumes are needed. Prothrombin complex concentrates (PCCs) are purified and viral inactivated concentrates of vitamin K-dependent coagulation factors, which are obtained from pooled normal plasma [24].…”

“…recently, a specific reversal agent against factor Xa inhibitors was developed, known as Andexanet alfa (PrT064445, AndexXa ® , Portola Pharmaceuticals, South San Francisco, CA, USA) [22]. Andexanet alfa is a modified human recombinant factor Xa which is catalytically inactive, though retains high-affinity binding to direct factor Xa inhibitors or heparin-antithrombin III complexes.…”