Thromb Haemost 2012; 108(04): 625-632
DOI: 10.1160/TH12-05-0319
Review Article
Schattauer GmbH

New direct oral anticoagulants – current therapeutic options and treatment recommendations for bleeding complications

Wolfgang Miesbach
1   Medical Clinic III, Institute of Transfusion Medicine, University Hospital, Frankfurt/Main, Germany
,
Erhard Seifried
2   Institute of Transfusion Medicine and Immunohaematology, DRK-Red Cross, University Hospital, Frankfurt/Main, Germany
› Author Affiliations
Further Information

Publication History

Received: 15 May 2012

Accepted after major revision: 21 June 2012

Publication Date:
29 November 2017 (online)

Summary

To date, clinical studies show that the incidence of spontaneous bleeding with new direct oral anticoagulants (DOAs) is comparable to that of established anticoagulants. However, unlike vitamin K antagonists, there are currently no clinically available antidotes or approved reversal agents for new DOAs. Restoring normal coagulation is important in many cases, such as emergency surgeries, serious bleedings, or anticoagulant overdosing. Attempts have been made to restore normal coagulation after treatment with new DOAs using compounds such as recombinant activated factor VII (rFVIIa), prothrombin complex concentrate (PCC), or FEIBA (factor eight inhibitor bypassing activity). Limited pre-clinical data and even less clinical evidence are available on the usefulness of these methods in restoring normal coagulation for the emergency management of critical bleeding episodes. Evaluating the utility of DOAs is further complicated by the fact that it is unknown how predictive established test systems are of the bleeding risks. Clinical practice requires further evaluation of the emergency management options for the new DOAs to define the agents and the doses that are most useful. Furthermore, patients receiving long-term treatment with a DOA are likely to undergo elective surgery at some point, and there is lack of evidence regarding perioperative treatment regimens under such conditions. This review summarises potential bleeding management options and available data on the new DOAs.

 
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