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Bleeding complications from the direct oral anticoagulants
Michelle Sholzberg1, Katerina Pavenski2, Nadine Shehata3
1Division of Hematology, Department of Medicine and Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Room 2-007G Core Lab, Carter Wing, Toronto, ON M5B-1 W8 Canada.
BMC Hematology
|December 26, 2015
Summary
Managing bleeding from direct oral anticoagulants (DOACs) is challenging due to variable strategies and lack of specific reversal agents. Further clinical trials are needed to standardize treatment for DOAC-associated bleeding.
Area of Science:
- Hematology
- Pharmacology
- Clinical Medicine
Background:
- Direct oral anticoagulants (DOACs) are standard for thromboembolic risk management.
- Managing DOAC-associated bleeding is a clinical challenge due to the absence of specific antidotes.
- This study examines the multicenter experience in Toronto, Canada, with bleeding events related to dabigatran and rivaroxaban.
Purpose of the Study:
- To describe the management of direct oral anticoagulant (DOAC)-associated bleeding.
- To analyze bleeding characteristics and patient outcomes in a real-world clinical setting.
- To identify inconsistencies in bleeding management strategies.
Main Methods:
- Retrospective chart review of 26 patients with DOAC bleeding.
- Data collected from five academic hospitals in Toronto, Canada (January 2011 - December 2013).
- Focus on bleeding events requiring hematology and/or transfusion medicine consultation.
Main Results:
- Intracranial (42%) and gastrointestinal (50%) bleeds were most common.
- All patients possessed known risk factors for DOAC bleeding.
- Variable management strategies were observed, with a median hospital stay of 11 days, 5 post-transfusion thromboembolic events, and 6 deaths.
Conclusions:
- Management of DOAC-associated bleeding is inconsistent and variable.
- There is a critical need for clinical trial data on DOAC reversal.
- Optimization and standardization of bleeding treatment algorithms are required.
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