Haematological management of major bleeding associated with direct oral anticoagulants – UK experience

Green, L. et al. (2019) Haematological management of major bleeding associated with direct oral anticoagulants – UK experience. British Journal of Haematology, 185(3), pp. 514-522. (doi: 10.1111/bjh.15808) (PMID:30784047)

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The lack of antidotes for activated factor X-inhibitor direct oral anticoagulants (DOACs) 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 DOACs. The proportion of major bleeds on DOACs 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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Tait, Dr Robert
Authors: Green, L., Tan, J., Antoniou, S., Alikhan, R., Curry, N., Everington, T., Saja, K., Stanworth, S., Tait, C., Morris, J. K., and MacCallum, P.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:British Journal of Haematology
ISSN (Online):1365-2141
Published Online:19 February 2019

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