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Published on: May 21, 2019
Hemorrhagic Events Associated With Direct Oral Anticoagulants: Frequency and Management
Mohamed Ztati1, Oussama Zaanouny1, Ayoub Nasim1
1Cardiology, Hospital Arrazi, Centre Hospitalo-Universitaire (CHU) Mohammed VI, Université Cadi Ayyad (UCA) Faculty of Medicine and Pharmacy in Marrakech, Marrakech, MAR.
Insights
Direct oral anticoagulants (DOACs) can cause bleeding, especially in elderly patients on multiple medications. This study found favorable outcomes in most cases despite challenges, emphasizing individualized care and better access to reversal agents.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Direct oral anticoagulants (DOACs) are widely used but carry bleeding risks.
- Elderly patients with polypharmacy are particularly vulnerable to DOAC-related bleeding complications.
Purpose of the Study:
- To analyze non-traumatic bleeding events related to DOAC use in a real-world setting.
- To identify common DOACs, bleeding presentations, and patient characteristics in a Moroccan tertiary cardiology center.
Main Methods:
- A three-year, cross-sectional study of 35 non-traumatic DOAC-related bleeding cases.
- Data collected included patient demographics, medication history, DOAC type, bleeding site, and outcomes.
Main Results:
- The average patient age was 67.5 years, with 89% on polypharmacy.
- Rivaroxaban was the most common DOAC (74%); gastrointestinal bleeding (46%) was the most frequent presentation.
- Major bleeding occurred in 34%, with favorable outcomes in 94% despite limited resources and no reversal agent use.
Conclusions:
- Individualized DOAC management and structured medication reviews are essential.
- Improved access to reversal agents and standardized protocols are crucial, especially in resource-limited settings.
- Clinician training is vital to align clinical practice with evidence-based guidelines for DOAC management.
Abstract:
Background Direct oral anticoagulants (DOACs) have transformed anticoagulation strategies, yet bleeding complications remain a significant concern, particularly in elderly patients with polypharmacy. Methodology In this three-year, cross-sectional study conducted at a tertiary cardiology center in Morocco, we analyzed 35 cases of non-traumatic DOAC-related bleeding. Results The mean patient age was 67.5 years, and 89% were on multiple medications. Rivaroxaban was the most prescribed DOAC (74%), and gastrointestinal bleeding was the most common presentation (46%), followed by intracerebral hemorrhage and epistaxis (14% each). Major bleeding occurred in 34% of cases; however, no specific reversal agents were used. Despite resource limitations, outcomes were favorable in 94% of patients, with only two deaths recorded. Conclusions These real-world findings highlight the importance of individualized DOAC management, structured medication reviews, and improved access to reversal agents. In resource-limited settings, standardized protocols and clinician training are crucial to bridge the gap between guideline recommendations and everyday clinical practice.
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