Key result
Management of DOAC-associated bleeding was highly variable, resulting in a median hospital stay of 11 days, 5 thromboembolic events following hemostatic therapy, and a 23% mortality rate.
Observational (n=26)
Yes
Management of DOAC-associated bleeding is highly variable and associated with significant morbidity and mortality, highlighting the need for standardized reversal algorithms.
Variable DOAC bleeding management associates with high morbidity; leaves open whether standardized protocols improve outcomes.
BACKGROUND: Direct oral anticoagulants (DOACs) are now standard of care for the management of thromboembolic risk. A prevalent issue of concern is how to manage direct oral anticoagulant (DOAC)-associated bleeding for which there is no specific antidote available for clinical use. We conducted a retrospective case series to describe the Toronto, Canada multicenter experience with bleeding from dabigatran or rivaroxaban. METHODS: Retrospective chart review of DOAC bleeding necessitating referral to hematology and/or transfusion medicine services at five large University of Toronto affiliated academic hospitals from January 2011 to December 2013. RESULTS: Twenty-six patients with DOAC bleeding were reviewed; 42 % bleeds intracranial and 50 %, gastrointestinal. All patients had at least one risk factor associated with DOAC bleeding reported in previous studies. Inconsistent bleed management strategies were evident. Median length of hospital stay was 11 days (1-90). Five thromboembolic events occurred after transfusion based-hemostatic therapy and there were six deaths. CONCLUSIONS: Management of DOAC bleeding is variable. Clinical trial data regarding DOAC reversal is needed to facilitate optimization and standardization of bleeding treatment algorithms.
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Sholzberg et al. (2015) conducted an observational in DOAC-associated bleeding (n=26). Direct oral anticoagulants (dabigatran or rivaroxaban) was evaluated on Management strategies and clinical outcomes of DOAC-associated bleeding. Management of DOAC-associated bleeding was highly variable, resulting in a median hospital stay of 11 days, 5 thromboembolic events following hemostatic therapy, and a 23% mortality rate.
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