Prevention and Treatment of Bleeding with Direct Oral Anticoagulants
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REVIEW ARTICLE
Prevention and Treatment of Bleeding with Direct Oral Anticoagulants R. Monroe Crawley1 · Rachel L. Anderson1
© Springer Nature Switzerland AG 2020
Abstract Anticoagulant-related bleeding carries considerable morbidity and mortality. Major or life-threatening bleeding is among the most severe of these complications. As the number of patients treated with direct oral anticoagulants (DOACs) continues to increase, so does the number of DOAC-related bleeding events. The incidence of CRNM bleeding related to DOAC therapy ranges from 15 to 18% per 100-year patients, while the incidence of major bleeding ranges from 2.71 to 3.6%. Many of these bleeding events can be prevented with tailored dosing regimens or proper peri-procedural management. When unable to be prevented, DOAC-related bleeding can lead to significant long-term disability or death. Management with newer reversal agents such as andexanet alfa and idarucizumab, as well as prothrombin complex concentrates, may improve outcomes for patients with DOAC-related bleeding. The purpose of this review is to explore strategies for preventing and treating bleeding in patients receiving DOACs for anticoagulant therapy.
Key Points
1 Introduction
DOAC-related bleeding is a serious, often life-threatening, complication.
Oral anticoagulation is often a necessary component of treatment for many common disease states. Treatment guidelines for cardiovascular diseases such as atrial fibrillation continue to emphasise the importance of anticoagulation to prevent thromboembolic complications [1]. As guideline recommendations emerge and the population grows, oral anticoagulant therapy continues to become more prevalent [2, 3]. Anticoagulant-induced bleeding remains the most detrimental complication associated with the use of these agents. Many strategies have been proposed to mitigate the bleeding risks associated with anticoagulation. As the utilisation of direct oral anticoagulants (DOACs) continues to increase, the number of bleeding-related adverse effects grows. Recommendations regarding the most effective strategies for the prevention of perioperative bleeding, management of minor haemorrhages, and urgent DOAC reversal in major/ life-threatening bleeding have been recently published. As new therapies for anticoagulant reversal emerge, clinical understanding of the mechanisms, efficacy, and potential safety concerns is essential to overall patient care.
Some bleeding events can be prevented with tailored dosing regimens and proper periprocedural management. However, when major/life-threatening bleeding occurs, management with specific reversal agents or PCCs may reduce overall mortality. Reviewing these concepts may help to better prepare healthcare professionals to provide safe and effective care to their patients.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40265-020-01345-5) contains supplementary material, which is available to authorized users. * R. Monroe Crawley [email protected] Ra
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