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New oral anticoagulants: clinical indications, monitoring and treatment of acute bleeding complications
Author(s) -
FENGERERIKSEN C.,
MÜNSTER A.M.,
GROVE E. L.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12319
Subject(s) - rivaroxaban , medicine , apixaban , dabigatran , partial thromboplastin time , warfarin , intensive care medicine , discovery and development of direct thrombin inhibitors , fresh frozen plasma , anticoagulant , prothrombin time , direct thrombin inhibitor , prothrombin complex concentrate , drug , thrombin , anesthesia , surgery , atrial fibrillation , coagulation , pharmacology , platelet
New oral anticoagulants like the direct thrombin inhibitor, dabigatran ( P radaxa®), and factor X a‐inhibitors, rivaroxaban ( X arelto®) and apixaban ( E liquis®) are available for prophylaxis and treatment of thromboembolic disease. They are emerging alternatives to warfarin and provide equal or better clinical outcome together with reduced need for routine monitoring. Methods for measuring drug concentrations are available, although a correlation between plasma drug concentrations and the risk of bleeding has not been firmly established. Standard laboratory measures like prothrombin time and activated partial thromboplastin time are not sensitive enough to detect thrombin or factor X a inhibition provided by new oral anticoagulants. Thus, these standard tests may only be used as a crude estimation of the actual anticoagulation status. Further challenges regarding patients receiving new oral anticoagulants who presents with major bleeding or need for emergency surgery pose a unique problem. No established agents are clinically available to reverse the anticoagulant effect, although preclinical data report prothrombin complex concentrate as more efficient than fresh frozen plasma or other prohaemostatic agents. This review summaries current knowledge on approved new oral anticoagulants and discusses clinical aspects of monitoring, with particular focus on the management of the bleeding patient.