Re-Initiation of Dabigatran and Direct Factor Xa Antagonists After a Major Bleed

Milling, Truman J.; Spyropoulos, Alex C.

doi:10.1016/j.amjmed.2016.06.006

Cited by 9 publications

(4 citation statements)

References 73 publications

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“…17 Specific to patients taking DOACs, a large review concluded that following GIB, anticoagulation could resume at 1-week post-bleed. 18 Our findings were consistent with these studies as the majority of both warfarin- and DOAC-treated patients restarted their anticoagulation following a GIB, although we were not able to report the timing upon restarting.…”

Section: Discussionsupporting

confidence: 88%

“…20 For warfarin-treated patients who experience a minor bleeding event, they propose delaying the next dose of warfarin until the INR is less than 2.0 and delaying the next DOAC dose for 1 day. 18 There are limitations in this study that must be acknowledged. First, our sample size and number of different major and CRNM bleeding events was relatively small and therefore both types of bleeding events had to be grouped together as any bleeding events.…”

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Anticoagulation Changes Following Major and Clinically Relevant Nonmajor Bleeding Events in Non-valvular Atrial Fibrillation Patients

Feldeisen

Alexandris-Souphis

Haymart

et al. 2021

Journal of Pharmacy Practice

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Background Bleeding events are common complications of oral anticoagulant drugs, including both warfarin and the direct oral anticoagulants (DOACs). Some patients have their anticoagulant changed or discontinued after experiencing a bleeding event, while others continue the same treatment. Differences in anticoagulation management between warfarin- and DOAC-treated patients following a bleeding event are unknown. Methods Patients with non-valvular atrial fibrillation from six anticoagulation clinics taking warfarin or DOAC therapy who experienced an International Society of Thrombosis and Haemostasis (ISTH)-defined major or clinically relevant non-major (CRNM) bleeding event were identified between 2016 and 2020. The primary outcome was management of the anticoagulant following bleeding (discontinuation, change in drug class, and restarting of same drug class). DOAC- and warfarin-treated patients were propensity matched based on the individual elements of the CHA2DS2-VASc and HAS-BLED scores as well as the severity of the bleeding event. Results Of the 509 patients on warfarin therapy and 246 on DOAC therapy who experienced a major or CRNM bleeding event, the majority of patients continued anticoagulation therapy. The majority of warfarin (231, 62.6%) and DOAC patients (201, 81.7%) restarted their previous anticoagulation. Conclusion Following a bleeding event, most patients restarted anticoagulation therapy, most often with the same type of anticoagulant that they previously had been taking.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 93%

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Anticoagulation Changes Following Major and Clinically Relevant Nonmajor Bleeding Events in Non-valvular Atrial Fibrillation Patients

Feldeisen

Alexandris-Souphis

Haymart

et al. 2021

Journal of Pharmacy Practice

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“…Restarting anticoagulation after major hemorrhage has become an area of interest in hopes of mitigating the later TEE disease burden after anticoagulant reversal or cessation for bleeding [24]. Most major hemorrhage patients, especially with GIBs but also many with ICHs, can be restarted in the weeks after the bleeding has stabilized, though guidelines differ on the timing [25,26].…”

Section: Discussionmentioning

confidence: 99%

Management of Factor Xa inhibitor-associated life-threatening major hemorrhage: A retrospective multi-center analysis

Milling¹,

Clark

Feronti

et al. 2018

The American Journal of Emergency Medicine

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Background Factor Xa (FXa) inhibitors, used for stroke prevention in atrial fibrillation and venous thromboembolism treatment and prevention, are the dominant non-Vitamin K oral anticoagulants on the market. While major bleeding may be less common with these agents compared to warfarin, it is always a risk, and little has been published on the most serious bleeding scenarios. This study describes a cohort of patients with FXa inhibitor-associated life-threatening bleeding events, their clinical characteristics, interventions and outcomes. Methods We performed a retrospective, 5-center review of FXa inhibitor-treated major bleeding patients. Investigators identified potential cases by cross-referencing ICD-9/10 codes for hemorrhage with medication lists. Investigators selected cases they deemed to require immediate reversal of coagulopathy, and reviewed charts for characteristics, reversal strategies and other interventions, and outcomes. Results A total of 56 charts met the inclusion criteria for the retrospective cohort, including 29 (52%) gastrointestinal bleeds (GIB), 19 (34%) intracranial hemorrhages (ICH) and 8 (14%) others. Twenty-four (43%) patients received various factor or plasma products, and the remainder received supportive care. Thirty-day mortality was 21% (n = 12). Re-anticoagulation within 30-days occurred in 23 (41%) patients. Thromboembolic events (TEEs) occurred in 6 (11%) patients. No differences were observed in outcomes by treatment strategy. Conclusions This cohort of FXa inhibitor-associated major bleeding scenarios deemed appropriate for acute anticoagulant reversal illustrates the variable approaches in the absence of a specific reversal agent.

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Anticoagulant Reversal in Gastrointestinal Bleeding: Review of Treatment Guidelines

2021

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Re-Initiation of Dabigatran and Direct Factor Xa Antagonists After a Major Bleed

Cited by 9 publications

References 73 publications

Anticoagulation Changes Following Major and Clinically Relevant Nonmajor Bleeding Events in Non-valvular Atrial Fibrillation Patients

Anticoagulation Changes Following Major and Clinically Relevant Nonmajor Bleeding Events in Non-valvular Atrial Fibrillation Patients

Management of Factor Xa inhibitor-associated life-threatening major hemorrhage: A retrospective multi-center analysis

Anticoagulant Reversal in Gastrointestinal Bleeding: Review of Treatment Guidelines

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