Guideline on the management of bleeding in patients on antithrombotic agents

Autor: Michael Makris, Michael Laffan, Campbell Tait, Joost J. van Veen, Andrew D Mumford
Rok vydání: 2012
Předmět:
Zdroj: British Journal of Haematology. 160:35-46
ISSN: 0007-1048
DOI: 10.1111/bjh.12107
Popis: The guideline writing group was selected to be representativeof UK-based medical experts. The MEDLINE and EMBASEdatabases were searched systematically for publications in Eng-lish from 1966 to June 2011 and 1980 to June 2011 respec-tively, using the following strategy: Approved and proprietarynames of the antithrombotic agents described in the guidelinewere combined with terms relating to antidote, reversal, haem-orrhage, (activated) prothrombin complex concentrate, factorVIII inhibitor bypass activity (FEIBA), Beriplex, Octaplex,recombinant activated factor VII (rFVIIa), Novoseven, freshfrozen plasma, tranexamic acid, antifibrinolytic, platelet trans-fusion, and desmopressin. Identified papers were also searchedfor additional references. The writing group produced the draftguideline which was subsequently revised by consensus bymembers of the Haemostasis and Thrombosis task Force of theBritish Committee for Standards in Haematology (BCSH).The guideline was then reviewed by a sounding board ofapproximately 50 UK haematologists, the BCSH and theBritish Society for Haematology Committee and commentsincorporated where appropriate. Criteria used to quote levelsand grades of evidence are as outlined in: http://www.bcshguidelines.com/BCSH_PROCESS/EVIDENCE_LEVELS_AND_GRADES_OF_RECOMMENDATION/43_GRADE.html.The objective of this document is to guide healthcareprofessionals on the management of patients receivingantithrombotic drugs who experience significant bleeding orwho require emergency surgery or an invasive procedure.Guidance on reversal of vitamin K antagonists (VKAs;warfarin, phenprocoumon, acenocoumarol (sinthrome) andphenindione has been described previously (Keeling et al,2011).Antithrombotic drugs are used increasingly in patientgroups at greater bleeding risk. Although major haemorrhageis infrequent, management can be difficult especially withantithrombotics for which there are no specific reversalagents. Bleeding during antithrombotic therapy is associatedwith high morbidity and mortality (Linkins et al, 2003; Eikel-boom et al, 2006; Mannucci & Levi, 2007). Before any anti-thrombotic treatment is started, the risks and benefits shouldbe carefully considered. In this guideline we consider themanagement of bleeding in patients on the more widely usedantithrombotic agents including heparin, anti-IIa and anti-Xainhibitors, oral VKAs, anti-platelet drugs as well as the fibri-nolytic agents.
Databáze: OpenAIRE
Externí odkaz: