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Int J Cardiol. 2018 Oct 1;268:75-79. doi: 10.1016/j.ijcard.2018.05.060. Epub 2018 May 21.

Major bleeding with old and novel oral anticoagulants: How to manage it. Focus on reversal agents.

Author information

1
Cardiology Unit, San Filippo Neri Hospital, Rome, Italy. Electronic address: stefaniaa.difusco@aslroma1.it.
2
Cardiology Department, Big Metropolitan Hospital Melacrino Morelli, Reggio Calabria, Italy.
3
Cardiology Unit, Augusto Murri Hospital, Fermo, Italy.
4
Cardiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
5
Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilevo Nazionale e Alta Specialità, Catania, Italy.
6
Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
7
Cardiology Department, San Camillo Forlanini Hospital, Rome, Italy.
8
Cardiology Unit, San Filippo Neri Hospital, Rome, Italy.
9
Cardiovascular Center, Trieste Hospital, Italy.

Abstract

Even though vitamin K antagonists (VKAs) have been employed for >50 years, there is still some uncertainty about the best strategy to reverse anticoagulation due to VKAs in cases of major bleeding. Furthermore, there is also scarce evidence about the most appropriate way to treat serious bleeding associated with non-vitamin K antagonist oral anticoagulants. This review analyses the main advantages and disadvantages of the various forthcoming therapeutic options to restore a normal coagulation status in anticoagulated patients with ongoing serious bleeding. It discusses the role of fresh frozen plasma, prothrombin complex concentrates and recombinant factor VII activated. Moreover, we report updated evidence on antidotes currently available or in development. Finally, this article proposes a comprehensive algorithm that summarizes major bleeding management during treatment with oral anticoagulants.

KEYWORDS:

Anticoagulant antidotes; Major bleeding; Non-vitamin K antagonist oral anticoagulants; Reversal agents; Vitamin-K antagonists; Warfarin

PMID:
29843897
DOI:
10.1016/j.ijcard.2018.05.060
[Indexed for MEDLINE]

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