TY - JOUR
T1 - Re-initiation of dabigatran and direct factor Xa antagonists after a major bleed
AU - Milling, Truman J.
AU - Spyropoulos, Alex C.
N1 - Publisher Copyright:
© 2016 The Authors
PY - 2016/11
Y1 - 2016/11
N2 - Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence.
AB - Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence.
UR - http://www.scopus.com/inward/record.url?scp=85028264589&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2016.09.049
DO - 10.1016/j.ajem.2016.09.049
M3 - Review article
C2 - 27697440
AN - SCOPUS:85028264589
SN - 0735-6757
VL - 34
SP - 19
EP - 25
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 11
ER -