Affordable Access

deepdyve-link
Publisher Website

Treatment of bleeding complications in patients on anticoagulant therapy.

Authors
  • Piran, Siavash1
  • Schulman, Sam1, 2
  • 1 Department of Medicine, Division of Hematology and Thromboembolism, and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada; and. , (Canada)
  • 2 Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia.
Type
Published Article
Journal
Blood
Publisher
American Society of Hematology
Publication Date
Jan 31, 2019
Volume
133
Issue
5
Pages
425–435
Identifiers
DOI: 10.1182/blood-2018-06-820746
PMID: 30559261
Source
Medline
Language
English
License
Unknown

Abstract

Anticoagulant therapy is often refrained from out of fear of hemorrhagic complications. The most frequent type of major bleeding is gastrointestinal, but intracranial hemorrhage has the worst prognosis. Management of these complications in patients on anticoagulants should follow the same routines as for nonanticoagulated patients, as described here with the previously mentioned bleeds as examples. In addition, for life-threatening or massive hemorrhages, reversal of the anticoagulant effect is also crucial. Adequate reversal requires information on which anticoagulant the patient has taken and when the last dose was ingested. Laboratory data can be of some help, but not for all anticoagulants in the emergency setting. This is reviewed here for the different types of anticoagulants: vitamin K antagonists, heparins, fondaparinux, thrombin inhibitors and factor Xa inhibitors. Specific antidotes for the latter are becoming available, but supportive care and nonspecific support for hemostasis with antifibrinolytic agents or prothrombin complex concentrates, which are widely available, should be kept in mind. © 2019 by The American Society of Hematology.

Report this publication

Statistics

Seen <100 times