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Prevention and Treatment of Bleeding with Direct Oral Anticoagulants

Drugs volume 80, pages 1293–1308 (2020)Cite this article

Abstract

Anticoagulant-related bleeding carries considerable morbidity and mortality. Major or life-threatening bleeding is among the most severe of these complications. As the number of patients treated with direct oral anticoagulants (DOACs) continues to increase, so does the number of DOAC-related bleeding events. The incidence of CRNM bleeding related to DOAC therapy ranges from 15 to 18% per 100-year patients, while the incidence of major bleeding ranges from 2.71 to 3.6%. Many of these bleeding events can be prevented with tailored dosing regimens or proper peri-procedural management. When unable to be prevented, DOAC-related bleeding can lead to significant long-term disability or death. Management with newer reversal agents such as andexanet alfa and idarucizumab, as well as prothrombin complex concentrates, may improve outcomes for patients with DOAC-related bleeding. The purpose of this review is to explore strategies for preventing and treating bleeding in patients receiving DOACs for anticoagulant therapy.

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  1. Department of Pharmacy, Huntsville Hospital, 101 Sivley Road, Huntsville, AL, 35801, USA

    R. Monroe Crawley & Rachel L. Anderson

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RMC: concept and design; critical writing of intellectual content; and final approval of the version to be published. RLA: Periprocedural withholding; minor/non-life-threatening bleeding; resuming anticoagulation after major bleeding; revising the intellectual content; and final approval of the version to be published.

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Correspondence to R. Monroe Crawley.

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RMC and RLA declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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Crawley, R.M., Anderson, R.L. Prevention and Treatment of Bleeding with Direct Oral Anticoagulants. Drugs 80, 1293–1308 (2020). https://doi.org/10.1007/s40265-020-01345-5

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