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- Box 1: Potential management strategies for bleeding caused by direct oral anticoagulants and warfarin
Agent Strategy Warfarin Vitamin K, PCC, FP, TXA Dabigatran Activated charcoal, hemodialysis, aPCC, TXA or idarucizumab Rivaroxaban PCC, TXA Apixaban PCC, TXA Note: aPCC = activated prothrombin concentrates, FP = frozen plasma, PCC = prothrombin complex concentrates, TXA = tranexamic acid.
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Direct oral anticoagulants and the bleeding patient
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- Direct oral anticoagulant agents are now routinely used for the prevention of stroke in nonvalvular atrial fibrillation
- Risk of bleeding with direct oral anticoagulants is lower than with vitamin K antagonists, but varies by site
- Direct oral anticoagulants are characterized by rapid onset of action and short half-lives2
- Direct oral anticoagulants variably affect standard clot-based assays
- Idarucizumab has recently been approved by the US Food and Drug Administration to reverse the activity of dabigatran
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