Reversal agents for oral anticoagulant-associated major or life-threatening bleeding

AbstractOral anticoagulants (OA) are effective drugs for treating and preventing the formation of blood clots in patients with atrial fibrillation, mechanical heart valves and venous thromboembolism but their therapeutic effect is always counterbalanced by an increased risk of bleeding. Direct oral anticoagulants (DOACs) have brought advantages in the management of many patients, with evidence of a lower risk of intracranial bleeding in comparison to vitamin K antagonists (VKAs). However, due to the increased number of anticoagulated patients worldwide, major and life threatening OA-related bleeding is also increasing, and effective reversal strategies are needed. We reviewed the reversal strategies for both VKAs and DOACs in the light of the latest evidence and recent guidelines, taking into account non-specific methods with fresh frozen plasma (FFP), prothrombin complex concentrate (PCC) or four factor PCC, as well as specific reversal antidotes that are already approved or in approval phase. Most published studies on OA reversal have drawbacks, such as lacking a control arm or data on clinically relevant outcomes, and current guidelines ’ recommendations are mainly based on panellists’ judgment. There is an urgent need for well-designed studies in this field. In the meanwhile, to improve the correct use of available resources and patients’ outcomes, we suggest a seven-element bundle for an optimal management of OA-associated major bleeding, including the ...
Source: Internal and Emergency Medicine - Category: Emergency Medicine Source Type: research

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AbstractPurpose of ReviewThe anticoagulation strategies for various cardiac-specific pathologies including atrial fibrillation are changing. Applying these strategies in patients with concomitant active cancer requires additional considerations. Here, we review the most recent changes in the anticoagulation management of common cardiac diseases and their application in cancer patients.Recent FindingsThere are a range of indications for therapeutic anticoagulation in cancer patients including venous thromboembolism (VTE), atrial fibrillation/flutter (AF/AFL), prosthetic heart valves, and intracardiac thrombi. Certain cancer...
Source: Current Oncology Reports - Category: Cancer & Oncology Source Type: research
Abstract Oral anticoagulants (OAC) are widely used for prevention of systemic thromboembolism, including the reduction of the risk of stroke in patients with atrial fibrillation (AF) and prosthetic heart valves. There is also an increasing population of patients who require not only OACs, but also double antiplatelet therapy (DAPT). A typical example is a patient with AF and stable coronary artery disease or acute coronary syndrome (ACS), treated by percutaneous coronary intervention (PCI). In recent years, with the introduction of NOACs, triple or dual therapy has become safer. Regardless of these indications for...
Source: Polish Heart Journal - Category: Cardiology Authors: Tags: Kardiol Pol Source Type: research
BackgroundIt remains uncertain if patients with atrial fibrillation or mechanical heart valves requiring interruption of warfarin for procedures benefit from post-procedure anticoagulant bridging therapy.MethodsIn order to determine the efficacy and safety of postoperative LMWH bridging, we conducted a multicenter randomized double-blind controlled trial of patients with atrial fibrillation or a mechanical heart valve who require interruption of warfarin for a planned procedure. We excluded patients with active bleeding within 30 days, platelet count
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy: Management of Challenging Patients and Scenarios Source Type: research
Background: Traditional prothrombin time (PT) based international normalized ratio (INR) is often highly variable. Often this is caused by rapid factor VII reductions due to its short (4 hour) half-life. Thus, factor VII variation is an important confounder during vitamin K antagonist (VKA) dosing. Furthermore, prior studies have demonstrated that factor VII reductions only minimally influence the antithrombotic effect and bleeding risk of VKA, the clinical effect depending mainly on controlled reduction of factors II and X. Therefore, ignoring the influence of FVII during VKA monitoring has the potential to simplify manag...
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy: Poster I Source Type: research
Authors: Andrade JG, Meseguer E, Didier R, Dussault C, Weitz JI Abstract INTRODUCTION: The non-vitamin K antagonist oral anticoagulants (NOACs), which include dabigatran, apixaban, edoxaban and rivaroxaban, are preferred over vitamin K antagonists for stoke prevention in most patients with non-valvular atrial fibrillation. The NOACs are contraindicated in atrial fibrillation patients with rheumatic mitral stenosis or mechanical heart valves. There is evidence that bioprosthetic heart valves are less thrombogenic than mechanical heart valves, but it is unknown whether the risk of thromboembolism in atrial fibrillati...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
This article summarizes the clinical pharmacology of these drugs and identifies knowledge gaps in the literature related to their use. PMID: 29802125 [PubMed - as supplied by publisher]
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF), and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain. In 2013, the first “EHRA Practical Guide” was published to provide practical guidance for situations; an update was published in 2015...
Source: European Heart Journal - Category: Cardiology Source Type: research
WARFARIN AND VITAMIN K antagonists (VKA) are used widely for a number of conditions, including a history of deep venous thrombosis, pulmonary embolism, atrial fibrillation, mechanical heart valves, poor left ventricular function, and hypercoagulable states. Spontaneous bleeding is a known complication of VKA therapy and can lead to significant morbidity and mortality.1 –3 Major bleeding from a supra-therapeutic international normalized ratio (INR) with warfarin therapy can occur in up to 6.5% of patients annually; the risks of major bleeding complications, including intracranial and gastrointestinal sources, are incr...
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Pro and Con Source Type: research
Semin Thromb Hemost DOI: 10.1055/s-0037-1615261This is an observational study to investigate the efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with bioprosthetic valves or prior surgical valve repair in clinical practice. A total of 122 patients (mean age: 74.1 ± 13.2; 54 females) with bioprosthetic heart valve or surgical valve repair and AF treated with NOACs were included in the analysis. The mean CHA2DS2-VASc (Congestive heart failure, Hypertension, Age>75 years, Diabetes mellitus, prior Stroke or transient ischemic attack, Vascul...
Source: Seminars in Thrombosis and Hemostasis - Category: Hematology Authors: Tags: Original Article Source Type: research
CARDIAC SURGICAL PATIENTS may bleed for multiple reasons that are related to acquired coagulopathy during surgery or from underlying disease processes that predispose to inflammation and hemorrhage. Patients also may have pre-existing hemostatic derangements due to the growing and widespread use of anticoagulants for cardiovascular disease; these may include patients with atrial fibrillation, mechanical heart valves, venous thromboembolism, or ventricular assist devices. Bleeding in these settings can be amplified by the inflammatory cascade associated with extracorporeal blood flow through the cardiopulmonary bypass circu...
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Pro and Con Source Type: research
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