Re-Initiation of Dabigatran and Direct Factor Xa Antagonists After a Major Bleed

Truman J. Milling, Alex C. Spyropoulos

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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.

Original languageEnglish
Pages (from-to)S54-S63
JournalAmerican Journal of Medicine
Issue number11
StatePublished - 1 Nov 2016
Externally publishedYes


  • Direct-acting oral anticoagulants
  • Gastrointestinal bleeding
  • Intracranial hemorrhage
  • Major hemorrhage
  • Restart oral anticoagulants
  • Warfarin


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