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Haematological management of major bleeding associated with direct oral anticoagulants – UK experience
Author(s) -
Green Laura,
Tan Joachim,
Antoniou Sotiris,
Alikhan Raza,
Curry Nicola,
Everington Tamara,
Saja Khalid,
Stanworth Simon,
Tait Campbell,
Morris Joan K.,
MacCallum Peter
Publication year - 2019
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15808
Subject(s) - medicine , dabigatran , edoxaban , rivaroxaban , apixaban , hazard ratio , confidence interval , gastrointestinal bleeding , medical prescription , prothrombin complex concentrate , warfarin , atrial fibrillation , pharmacology
Summary The lack of antidotes for activated factor X‐inhibitor direct oral anticoagulants ( DOAC s) means that management of bleeding consists largely of existing supportive therapies. This study aimed to: (i) examine the relative frequency of DOAC ‐related major bleeding in relation to DOAC prescriptions over the study period; (ii) describe the presentation and haematological management of DOAC ‐related major bleeding; and (iii) evaluate the association between the use of prothrombin‐complex‐concentrate ( PCC ) and in‐hospital mortality. Over a 3‐year period, 32 UK hospitals submitted data on haematological management of DOAC ‐related bleeding. Data consisted of 421 episodes (67%, 21%, 11% and 1% on rivaroxaban, apixaban, dabigatran and edoxaban respectively) of major bleeding on DOAC s. The proportion of major bleeds on DOAC s and DOAC prescriptions increased throughout the study. Overall, 44% and 37% of patients presented with gastrointestinal bleeding and intracranial haemorrhage ( ICH ) respectively. Drug concentrations were seldom measured. Compared to no PCC , there was a borderline evidence that receiving low dose PCC (≤25 iu/kg) was associated with better outcomes in terms of mortality (sub‐distribution hazard ratio: 0·15; 95% confidence interval: 0·02–1·19; P = 0·07): but this was not the case for higher doses. DOAC concentrations are seldom measured. There was no evidence of benefit for PCC on in‐hospital mortality.