Management of Severe Bleeding in Patients Treated with Direct Oral Anticoagulants

Albaladéjo, Pierre; Samama, Charles‐Marc; Sié, P.; Kauffmann, S.; Mémier, Vincent; Suchon, Pierre; Viallon, Alain; David, Jean-Stéphane; Gruel, Yves; Bellamy, Lorenn; Maistre, Emmanuel de; Romegoux, Pauline; Thoret, Sophie; Pernod, Gilles; Bosson, Jean‐Luc

doi:10.1097/aln.0000000000001631

Cited by 53 publications

(50 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent study by Song et al suggested that 50 IU/kg PCC was effective in reversing the anticoagulant action of apixaban as well [26]. e efficacy of PCCs on clinical outcomes on patients with NOACs and active bleeding is not yet established in a randomized control trial although observational studies are suggestive of efficacy in achieving hemostasis [27]. e European Heart Association recommends the use of PCC or aPCC in the absence of specific reversal agents in patients with major bleeding.…”

Section: Nonspecific Reversal Agentsmentioning

confidence: 99%

An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants

Mujer

Manoj

Atti

et al. 2020

Advances in Hematology

View full text Add to dashboard Cite

Non-vitamin K antagonist oral anticoagulants (NOACs) include thrombin inhibitor dabigatran and coagulation factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and betrixaban. NOACs have several benefits over warfarin, including faster time to the achieve effect, rapid onset of action, fewer documented food and drug interactions, lack of need for routine INR monitoring, and improved patient satisfaction. Local hemostatic measures, supportive care, and withholding the next NOAC dose are usually sufficient to achieve hemostasis among patients presenting with minor bleeding. The administration of reversal agents should be considered in patients on NOAC's with major bleeding manifestations (life-threatening bleeding, or major uncontrolled bleeding), or those who require rapid anticoagulant reversal for an emergent surgical procedure. The Food and Drug Administration (FDA) has approved two reversal agents for NOACs: idarucizumab for dabigatran and andexanet alfa for apixaban and rivaroxaban. The American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS) have released an updated guideline for the management of patients with atrial fibrillation that provides indications for the use of these reversal agents. In addition, the final results of the ANNEXA-4 study that evaluated the efficacy and safety of andexanet alfa were recently published. Several agents are in different phases of clinical trials, and among them, ciraparantag has shown promising results. However, their higher cost and limited availability remains a concern. Here, we provide a brief review of the available reversal agents for NOACs (nonspecific and specific), recent updates on reversal strategies, lab parameters (including point-of-care tests), NOAC resumption, and agents in development.

show abstract

Section: Nonspecific Reversal Agentsmentioning

confidence: 99%

An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants

Mujer

Manoj

Atti

et al. 2020

Advances in Hematology

View full text Add to dashboard Cite

show abstract

“…Nonspecific hemostatic agents such as recombinant factor VII, factor VIII inhibitor bypassing activity, or PCCs have been suggested based on clinical need. [321][322][323] A dabigatran-directed neutralizing antibody, idarucizumab, has been approved for use. A prospective study showed that idarucizumab normalized the elevated ECT in 88% to 98% of patients, an effect that was seen within minutes.…”

Section: Dabigatranmentioning

confidence: 99%

“…344 Nonspecific hemostatic agents, including recombinant factor VII and PCCs, may be used to reverse the NOACs. [321][322][323] Andexanet is a recombinant modified human factor Xa decoy protein that binds and sequesters factor Xa inhibitors within the vascular space, restoring the factor Xa activity. A 2-part randomized, placebo-controlled study was recently conducted in older healthy volunteers.…”

Section: Rivaroxabanmentioning

confidence: 99%

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition)

Narouze

Benzon

Provenzano³

et al. 2017

Regional Anesthesia and Pain Medicine

113

View full text Add to dashboard Cite

The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation. The first guidelines specific to interventional spine and pain procedures were published in 2015. Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines. The latest evidence was sought through extensive database search strategies and the recommendations were evidence based when available and pharmacology driven otherwise. We could not provide strength and grading of these recommendations because there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations. This publication is intended as a living document to be updated periodically with consideration of new evidence.

show abstract

“…In such situations, percutaneous or surgical left atrial appendage occlusion may be considered as a valuable option instead of long-term anticoagulation [1,4,100]. Finally, whether the use of PCC or aPCC is useful in NOAC-related intracranial bleeding is still hotly debated [101][102][103][104] since a multicentre analysis did not reveal a significant benefit on hematoma enlargement [105]. In patients with intracranial bleeding caused by dabigatran, reversal of the anticoagulant effect is possible by infusion of reversal agent, idarucizumab.…”

Section: Life-threatening Bleedingsmentioning

confidence: 99%