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Management of Bleeding Complications in Patients Taking Direct Oral Anticoagulants at a Large Tertiary Academic Medical Center

  • Thrombosis (D. Slattery, Section Editor)
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Abstract

Direct oral anticoagulants (DOACs) offer a fixed-dose alternative to warfarin for stroke prevention in patients with atrial fibrillation. However, there is minimal evidence to guide the management of bleeding in patients taking a DOAC. We retrospectively evaluated the acute management of major bleeding in this patient population at a large, tertiary academic medical center. We evaluated various strategies of management including dialysis, transfusions, pharmacologic agents, surgical intervention, and reinitiation of anticoagulation. We also assessed length of intensive care unit and hospital stay, mortality, and laboratory markers for coagulation. Thirteen patients were included in this analysis; ten patients were taking dabigatran; and three were taking rivaroxaban. Eight patients were treated for gastrointestinal bleeding; four for subarachnoid hemorrhage; and one for a retroperitoneal bleed. No patients received concentrated coagulation factors; five received packed red blood cells; two received packed red blood cells and platelets; one received fresh frozen plasma; and one received fresh frozen plasma and packed red blood cells. No patients required dialysis and two patients who experienced subarachnoid hemorrhages needed surgical interventions. The average hematocrit on presentation was 29.1 ± 6.8 % and was 33.7 ± 3.7 % 3 days after presentation. Therapeutic anticoagulation was restarted during admission on six patients; two were restarted on their original anticoagulant, while four received an alternative agent. Patients treated for a non-intracranial major bleed while taking a DOAC at our institution have been managed with supportive care alone without the need for concentrated coagulation factors.

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Acknowledgments

All authors were involved with the conception, the study, and the design of the trial. No funds were obtained for this research. C.A.S, L.M, B.G, and J.A supervised the conduct of the trial and data collection. C.A.S, H.D, and D.P.R conducted data collection. C.A.S and JA provided statistical advice on study design and analyzed the data. C.A.S, H.D, and D.P.R drafted the manuscript, and all authors contributed substantially to its revision. C.A.S takes responsibility for the paper as a whole.

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Authors and Affiliations

  1. Department of Pharmacy Services, Brigham and Women’s Hospital, 75 Francis Street, TR-L2, Boston, MA, 02115, USA

    Craig A. Stevens, Heather Dell’Orfano, Lina Matta & Julie Atay

  2. Department of Pharmacy, Yale New Haven Hospital, 20 York St, New Haven, CT, 06510, USA

    David P. Reardon

  3. Department of Clinical Pharmacy Services, University of Massachusetts Medical School, 55 N. Lake Ave, Worcester, MA, 01655, USA

    Bonnie Greenwood

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  1. Craig A. Stevens
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Correspondence to Craig A. Stevens.

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This article is part of the Topical Collection on Thrombosis.

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Stevens, C.A., Dell’Orfano, H., Reardon, D.P. et al. Management of Bleeding Complications in Patients Taking Direct Oral Anticoagulants at a Large Tertiary Academic Medical Center. Curr Emerg Hosp Med Rep 3, 162–167 (2015). https://doi.org/10.1007/s40138-015-0079-5

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  • DOI: https://doi.org/10.1007/s40138-015-0079-5

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