Emergency care of patients receiving non-vitamin K antagonist oral anticoagulants |
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| Authors: | J.W. Eikelboom S. Kozek-Langenecker A. Exadaktylos A. Batorova Z. Boda F. Christory I. Gornik G. Kėkštas A. Kher R. Komadina O. Koval G. Mitic T. Novikova E. Pazvanska S. Ratobilska J. Sütt A. Winder D. Zateyshchikov |
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| Affiliation: | 1. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada;2. Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria;3. Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland;4. Department of Haematology and Transfusion Medicine, Faculty of Medicine of Comenius University, and University Hospital, Bratislava, Slovakia;5. Department of Internal Medicine, Thrombosis and Haemostasis Centre, University of Debrecen, Debrecen, Hungary;6. Medical Education Global Solutions, Paris, France;7. Intensive Care Unit, Department of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia;8. Department of Anaesthesiology and Intensive Care, Vilnius University Hospital Santari?ki? Klinikos, Vilnius, Lithuania;9. Laboratory of Biological Hematology, Hôtel-Dieu University Hospital, Paris, France;10. Department of Traumatology, General and Teaching Hospital Celje, Celje, Slovenia;11. Department of Hospital Therapy No. 2, Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine;12. Thrombosis and Haemostasis Unit, Centre of Laboratory Medicine, Clinical Centre of Vojvodina, and Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia;13. Department of Cardiology, Northwestern Medical University I. I. Mechnikov, and Vascular Centre, Pokrovskaya City Hospital, Saint Petersburg, Russian Federation;14. Department Anaesthesia and Intensive Care, 4th City Hospital, Sofia, Bulgaria;15. Intensive Care Unit, Pauls Stradins Clinical University Hospital, Riga, Latvia;16. Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia;17. Department of Hematology, Thrombosis and Hemostasis Unit, Wolfson Medical Center, Holon, Israel;18. Primary Vascular Department, City Clinical Hospital No. 51, Moscow, Russia;19. University of Zagreb School of Medicine, Zagreb, Croatia |
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| Abstract: | Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, edoxaban) have been introduced in several clinical indications. Although NOACs have a favourable benefit-risk profile and can be used without routine laboratory monitoring, they are associated–as any anticoagulant–with a risk of bleeding. In addition, treatment may need to be interrupted in patients who need surgery or other procedures. The objective of this article, developed by a multidisciplinary panel of experts in thrombosis and haemostasis, is to provide an update on the management of NOAC-treated patients who experience a bleeding episode or require an urgent procedure. Recent advances in the development of targeted reversal agents are expected to help streamline the management of NOAC-treated patients in whom rapid reversal of anticoagulation is required. |
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| Keywords: | anticoagulants coagulation monitoring emergencies haemorrhage reversal |
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