Key result
Management of bleeding from dabigatran, rivaroxaban, and apixaban relies on supportive care, drug withdrawal, and potentially off-label use of nonspecific hemostatic agents for severe cases.
Provides practical guidance on managing bleeding complications associated with new oral anticoagulants in the absence of specific antidotes.
May guide interim supportive protocols for NOAC bleeding; leaves open randomized trials of reversal strategies.
The new oral anticoagulants dabigatran etexilate (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis) have predictable pharmacokinetic and pharmacodynamic profiles and are alternatives to warfarin. However, many physicians are wary of these drugs, since there is limited evidence on how to manage bleeding in patients taking them, and since no specific antidote is known to reverse their anticoagulant effect. Management requires careful adherence to first principles of bleeding care. Unapproved and untested reversal strategies may be required in patients with life-threatening bleeding.
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Fawole et al. (2013) conducted a review in Bleeding complications associated with new oral anticoagulants. Management strategies for bleeding (supportive care, nonspecific hemostatic agents) was evaluated. Management of bleeding from dabigatran, rivaroxaban, and apixaban relies on supportive care, drug withdrawal, and potentially off-label use of nonspecific hemostatic agents for severe cases.
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