How I treat: target specific oral anticoagulant associated bleeding.
Blood. 2014 Jan 2;
Authors: Siegal DM, Garcia DA, Crowther MA
Target specific oral anticoagulants (TSOACs) that directly inhibit thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban) are effective and safe alternatives to vitamin K antagonists (VKA) and low molecular weight heparin (LMWH). While these agents have practical advantages compared to VKAs and LMWH, there are no antidotes that reverse their anticoagulant effect. Clinical evidence for the efficacy of non-specific therapies that promote formation of fibrin (prothrombin complex concentrate [PCC], activated prothrombin complex concentrate [aPCC], recombinant factor VIIa) in the setting of TSOAC-associated bleeding is lacking and these pro-hemostatic products are associated with a risk of thrombosis. In the absence of specific antidotes, addition of PCC or aPCC to maximum supportive therapy may be reasonable for patients with severe or life-threatening TSOAC-associated bleeding. Targeted antidotes for these agents are in development.
PMID: 24385535 [PubMed - as supplied by publisher]