| Autor: |
Rodrigues A; Serviço de Imuno-Hemoterapia, Unidade Local de Saúde (ULS) Santa Maria, 1649-028 Lisboa, Portugal., Gonçalves LR; Serviço de Imuno-Hemoterapia, Unidade Local de Saúde (ULS) São João, 4200-319 Porto, Portugal., Gregório T; Serviço de Medicina Interna e Unidade AVC, Unidade Local de Gaia e Espinho, 4434-502 Vila Nova de Gaia, Portugal.; CINTESIS-Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal., Baldaia C; Serviço de Medicina Intensiva, Unidade Local de Saúde (ULS) Santa Maria, 1649-028 Lisboa, Portugal.; Serviço de Gastroenterologia, Unidade Local de Saúde (ULS) Santa Maria, 1649-028 Lisboa, Portugal.; Clínica Universitária de Gastrenterologia, Faculdade de Medicina de Lisboa, 1649-028 Lisboa, Portugal., Santo GC; Serviço de Neurologia, Hospitais da Universidade de Coimbra, Unidade Local de Saúde (ULS) de Coimbra, 3004-561 Coimbra, Portugal.; Center for Innovative Biomedicine and Biotechnology (CiBB), Universidade de Coimbra, 3004-561 Coimbra, Portugal., Gouveia J; Serviço de Medicina Intensiva, Unidade Local de Saúde (ULS) Santa Maria, 1649-028 Lisboa, Portugal.; Clínica Universitária de Medicina Intensiva, Faculdade de Medicina de Lisboa, 1649-028 Lisboa, Portugal. |
| Abstrakt: |
Direct oral anticoagulants (DOACs) are increasingly being used due to their improved efficacy/safety ratio and lower clinical and economic burden when compared to vitamin K antagonists. However, bleeding is still the most frequent complication associated with DOACs, and although rare, bleeding episodes can be life-threatening or critical. The impact of DOAC anticoagulation activity during a bleeding event must be evaluated according to patient clinical assessment, dosage and time from last intake, the presence of comorbidities (especially kidney and liver dysfunction), and, whenever possible, coagulation tests. Unfortunately, DOACs' anticoagulation activity is not easily or usually detectable in routine common coagulation testing. Specific DOAC tests allow for specific drug monitoring, but they are too time consuming, and are usually unavailable in routine emergency practice. If a clinically relevant DOAC plasma concentration is assumed or proven in a severe bleeding scenario, DOAC reversal is needed to restore hemostasis. This experts' consensus provides a narrative review about DOAC reversal and practical life-threatening bleeding management in several scenarios (trauma, intracranial hemorrhage and gastrointestinal bleeding), focusing on the selection of patients to whom specific reversal agents should be given. |
