BACKGROUND: More and more patients are being treated with direct oral anticoagulants (DOAC). Under treatment with DOACs gastrointestinal bleeding appears to occur more frequently, particularly in the lower gastrointestinal tract, compared to treatment with vitamin K antagonists (e.g. warfarin). OBJECTIVE: A possible approach should now be elaborated in a joint effort by gastroenterologists and cardiologists. MATERIAL AND METHODS: A selective literatue search was carried out and own experiences were also included. RESULTS: The decision to perform procoagulant therapy by slowly injecting 30-50 IU prothrombin complex concentrate (PPSB) per kg body weight intravenously depends on various factors and should be assessed critically. Specific antidotes are awaiting approval. After a bleeding episode potentially controllable and reversible triggers must be excluded (e.g. drug interactions and renal impairment). The risk of recurrent bleeding and the risk of thromboembolic events have to be weighed against each other before deciding to readminister an anticoagulant and its form. Dose reduction and changing to apixaban (in reduced dosage) are options for risk reduction and vitamin K antagonists can also be considered. DISCUSSION: It is still unclear what role specific antidotes will play.
BACKGROUND: More and more patients are being treated with direct oral anticoagulants (DOAC). Under treatment with DOACsgastrointestinal bleeding appears to occur more frequently, particularly in the lower gastrointestinal tract, compared to treatment with vitamin K antagonists (e.g. warfarin). OBJECTIVE: A possible approach should now be elaborated in a joint effort by gastroenterologists and cardiologists. MATERIAL AND METHODS: A selective literatue search was carried out and own experiences were also included. RESULTS: The decision to perform procoagulant therapy by slowly injecting 30-50 IU prothrombin complex concentrate (PPSB) per kg body weight intravenously depends on various factors and should be assessed critically. Specific antidotes are awaiting approval. After a bleeding episode potentially controllable and reversible triggers must be excluded (e.g. drug interactions and renal impairment). The risk of recurrent bleeding and the risk of thromboembolic events have to be weighed against each other before deciding to readminister an anticoagulant and its form. Dose reduction and changing to apixaban (in reduced dosage) are options for risk reduction and vitamin K antagonists can also be considered. DISCUSSION: It is still unclear what role specific antidotes will play.
Authors: Theodore E Warkentin; Peter Margetts; Stuart J Connolly; Andre Lamy; Chris Ricci; John W Eikelboom Journal: Blood Date: 2012-03-01 Impact factor: 22.113
Authors: Jan Beyer-Westendorf; Kati Förster; Sven Pannach; Franziska Ebertz; Vera Gelbricht; Christoph Thieme; Franziska Michalski; Christina Köhler; Sebastian Werth; Kurtulus Sahin; Luise Tittl; Ulrike Hänsel; Norbert Weiss Journal: Blood Date: 2014-05-23 Impact factor: 22.113
Authors: A Koch; L Buendgens; H Dückers; J Bruensing; M Matthes; J Kunze; H H Lutz; T Luedde; J J W Tischendorf; C Trautwein; F Tacke Journal: Med Klin Intensivmed Notfmed Date: 2013-03-17 Impact factor: 0.840
Authors: M Spannagl; R Bauersachs; E S Debus; M Gawaz; H Gerlach; S Haas; V Hach-Wunderle; E Lindhoff-Last; H Riess; S Schellong; H Schinzel; C Bode Journal: Hamostaseologie Date: 2012 Impact factor: 1.778