Urgent Reversal of Direct Oral Anticoagulants in Critical and Life-Threatening Bleeding: A Multidisciplinary Expert Consensus

• Tipo: Outra Publicação em Revista Científica Internacional
• Data: 2024

Autores

Rodrigues, A (Autor) Outra; Gonçalves, LR (Autor) Outra; Gregório, T (Autor) FMUP; Baldaia, C (Autor) Outra; Santo, GC (Autor) Outra; Gouveia, J (Autor) Outra

Revista

Título: Journal of Clinical Medicine

Vol. 13 Nº 17

Página Final: 6842

ISSN: 2077-0383

Editora: MDPI

Indexação

ISI Web of Knowledge - 0 Citações

Scopus - 0 Citações

Outras Informações

ID Authenticus: P-017-E2R

DOI: 10.3390/jcm13226842

Abstract (EN): 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.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 30