Why the study?
DOAC-associated bleeding can be life-threatening and routine emergency tests do not easily detect DOAC activity, requiring practical guidance on DOAC reversal and patient selection.
This expert consensus provides practical guidance on the management and reversal of DOACs in patients presenting with critical or life-threatening bleeding.
Supports clinical judgment over unavailable assays to select reversal candidates; leaves open prospective validation of the expert algorithm.
Direct oral anticoagulants (DOACs) are increasingly being used due to their improved efficacy/safety ratio and lower clinical and economic burden when compared to vitamin K antagonists. However, bleeding is still the most frequent complication associated with DOACs, and although rare, bleeding episodes can be life-threatening or critical. The impact of DOAC anticoagulation activity during a bleeding event must be evaluated according to patient clinical assessment, dosage and time from last intake, the presence of comorbidities (especially kidney and liver dysfunction), and, whenever possible, coagulation tests. Unfortunately, DOACs' anticoagulation activity is not easily or usually detectable in routine common coagulation testing. Specific DOAC tests allow for specific drug monitoring, but they are too time consuming, and are usually unavailable in routine emergency practice. If a clinically relevant DOAC plasma concentration is assumed or proven in a severe bleeding scenario, DOAC reversal is needed to restore hemostasis. This experts' consensus provides a narrative review about DOAC reversal and practical life-threatening bleeding management in several scenarios (trauma, intracranial hemorrhage and gastrointestinal bleeding), focusing on the selection of patients to whom specific reversal agents should be given.
No takes yet. Share an insight, caveat, or question.
Rodrigues et al. (2024) conducted a review in Critical and life-threatening bleeding associated with direct oral anticoagulants. DOAC reversal was evaluated. This expert consensus provides practical guidance on DOAC reversal and the management of life-threatening bleeding in scenarios such as trauma, intracranial hemorrhage, and gastrointestinal bleeding.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: