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Expert Review of Hematology Volume 9, 2016 - Issue 1
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Review

How to effectively manage the event of bleeding complications when using anticoagulants

Maria Teresa SartoriClinical Medicine I, Department of Medicine, University of Padua, Padua, Italy
&
Paolo PrandoniCorrespondence[email protected]
Pages 37-50 | Published online: 17 Nov 2015

References

  • Papers of special note have been highlighted as:
  • • Of interest
  • •• Of considerable interest
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• Relevant meta-analysis pointing out the crucial role of severe renal failure in increasing the risk of bleeding complications in patients treated with low-molecular-weight heparins.

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• Clinical practice guidelines outlining the evidence-based management of anticoagulant treatment with vitamin K antagonists and parenteral anticoagulants; reversal strategies for vitamin K antagonist–related major bleeding with vitamin K and prothrombin complex concentrates are reported.

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•• Extended practice guidelines on the management of bleeding complications occurring while taking several antithrombotic drugs, including anticoagulants, antiplatelets and fibrinolytic agents. General measures and antithrombotic drug-specific indications are detailed.

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  • National Advisory Committee on Blood and Blood products. Recommendations for use of prothrombin complex concentrates in Canada [Internet]. 2014 [ cited 2014 May 16]. Available from: http://www.nacblood.ca/resources/guidelines/PCC-Recommendations-Final-2014-05-16.pdf
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•• Interesting recent review on 28 studies, including four randomized trials, reporting the use of prothrombin complex concentrates for emergency vitamin K antagonist reversal. The authors demonstrated that dosing strategies were not uniform among studies, but without evidence of superiority; in addition, they observed that a predefined prothrombin complex concentrate dosing protocol appeared to be essential in emergency vitamin K antagonist reversal.

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• Meta-analysis evaluating the risk of thrombotic complications using three-factor and four-factor prothrombin complex concentrates for reversal of vitamin K antagonists, demonstrating that the risk is quite low but deserves attention.

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•• Very extensive and detailed guide for managing patients taking direct oral anticoagulants in clinical practice. Strategies for the management of minor, major and life-threatening bleeding are suggested, including the use of prothrombin complex concentrates, activated prothrombin complex concentrates and recombinant factor VIIa.

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• Practical proposals on the laboratory and medical approach to patients on dabigatran or rivaroxaban presenting with major hemorrhage or urgent surgical need requiring anticoagulation reversal.

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• Detailed review on the ongoing research on new antidotes for anticoagulant drugs.

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• Interim analysis of an ongoing trial in dabigatran-treated patients with urgent need of anticoagulation reversal. Promising results on the efficacy and safety of the new antidote idarucizumab are presented.

  • Crowther MA, Lu G, Conley P, et al. Sustained reversal of apixaban anticoagulation with andexanet alpha using a bolus plus infusion regimen in a phase II placebo controlled trial [abstract]. Eur Heart J. 2014;35:137.
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