Management of major bleeding in patients treated with direct oral anticoagulants: from experience to standardized protocols

  • Sara Mascia Emergency Medicine specialist, AUSL of Reggio Emilia, Italy.
  • Anna Maria Ferrari Emergency Department, AUSL of Reggio Emilia, Italy.
  • Nicola Macarone Palmieri Emergency Room, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
  • Elisa Romagnoli Internal Medicine and Critical Area Unit, Policlinico di Modena, Italy.
  • Chiara Catena Emergency Medicine, University of Modena and Reggio Emilia, Italy.
  • Serena Scarabottini Emergency Medicine, University of Modena and Reggio Emilia, Italy.
  • Francesca Mori Emergency Medicine, University of Modena and Reggio Emilia, Italy.
  • Lucio Brugioni | luciob2362@gmail.com Internal Medicine and Critical Area Unit, Policlinico di Modena, Italy.

Abstract

Evaluation of clinical-laboratory-therapeutic management and related clinical outcomes (thrombotic-hemorrhagic complications) of patients undergoing treatment with direct oral anticoagulants (DOACs) during major bleeding. This is a two-year observational retrospective study. 27 cases of major bleeding in patients undergoing a therapy with DOACs presented to the Emergency Department of Arcispedale Santa Maria Nuova (Reggio Emilia Hospital). 16 cases (59%) underwent reversal of anticoagulation treatment: 19% using specific reversal therapy (idarucizumab) and 81% using non-specific agents [4-factor prothrombin complex concentrate (4F-PCC)]. Routine laboratory data were available for all the cases, but only for some patients it was possible to obtain the plasma dosage of the oral anticoagulant. Laboratory data confirm rapid correction of activated partial thromboplastin time within one hour from the reversal of anticoagulation with idarucizumab. The absence of correlation between standard blood tests and plasma drug dosage in patients treated with factor Xa Inhibitors was confirmed too. The management of major bleeding during treatment with DOACs using reversal therapy (idarucizumab) and non-specific reversal agent (4F-PCC) showed minimal thrombotic (0.3%) and hemorrhagic (0.3%) complications at 90 days; no events occurred after 6 months.

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Published
2020-06-17
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Original Articles
Keywords:
New oral anticoagulants, major bleeding, idarucizumab, factor Xa inhibitors, 4-factor prothrombin complex concentrate.
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How to Cite
Mascia, S., Ferrari, A. M., Macarone Palmieri, N., Romagnoli, E., Catena, C., Scarabottini, S., Mori, F., & Brugioni, L. (2020). Management of major bleeding in patients treated with direct oral anticoagulants: from experience to standardized protocols. Italian Journal of Medicine, 14(2), 43-48. https://doi.org/10.4081/itjm.2020.1224

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