Management of bleeding in patients on oral anticoagulants


Džiugas Krečkauskas1, Andrius Klimašauskas1 ,2

1Vilnius University, faculty of medicine

2Vilnius University Hospital, Santaros clinics


The major and most common complication of anticoagulants use is bleeding. Over the last decade three new anticoagulants – dabigatran (a direct thrombin inhibitor), rivaroxaban and apixaban ( direct factor Xa inhibitors) – have been approved and widely used as an alternative to warfarin for the prevention of stroke in atrial fibrillation, the prevention and treatment of deep vein thrombosis and pulmonary embolism.  Various clinical studies have shown that new oral anticoagulants are associated with a lower risk of major bleeding compared to vitamin K antagonists. In case of major and life – threatening bleeding, timely and appropriate bleeding management can reduce the risk and mortality of its complications. In such situations, not only transfusions of blood components are required, but also a specific anticoagulant medication that stops bleeding quickly and effectively. The possibility of administring an antidote such as idarucizumab, which binds strongly with the dabigatran molecule and quickly inhibits its anticoagulant effect, improves the safe and effective use of dabigatran. As the use of new oral anticoagulants increases, the frequency of their induced bleeding will increase, thus it is necessary to ensure that all these anticoagulants have an  antidote.

Keywords: novel oral anticoagulants, bleeding, antidote, warfarin, idarucizumab.