Optimal management of major bleeding on DOACs: not only reversal agents

  • Silvia Galliazzo
  • Alessandro SquizzatoEmail author

Direct oral anticoagulants (DOACs) are currently prescribed in more than 50% of patients affected by non-valvular atrial fibrillation (FANV) or venous thromboembolism [1, 2]. Data from post-marketing studies confirmed the favourable risk–benefit profile of DOACs when compared with vitamin K antagonist (VKA) [3, 4]. However, all anticoagulant drugs carry an intrinsic unavoidable bleeding risk. Although rare, major and life-threatening bleedings required a timely management, given their high case-fatality rate and potential morbidity. Well-defined and widely available management protocols are crucial to address these emergency situations without delay. The development of a first reversal agent, e.g., idarucizumab, opened the new era of DOAC-specific antidote to restore haemostasis on time. As Andexanet alpha is not licensed in many countries, factor Xa inhibitors’ reversal can be rapidly managed by bypass-agents, mainly prothrombin complex concentrate (PCC) [5]. Despite four-factor PCC...


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Conflict of interest

Alessandro Squizzato received fees for lectures and/or advisory board meetings from Daiichi Sankyo, Pfizer, Bristol Myers Squibb, Bayer, Boehringer Ingelheim. Silvia Galliazzo, nothing to disclose.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent



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© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.Research Center on Thromboembolic Disorders and Antithrombotic Therapies, Department of Medicine and Surgery, School of MedicineUniversity of InsubriaVareseItaly

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