Editor’s Pick: Minimisation of Bleeding Risks Due to Direct Oral Anticoagulants

Direct oral anticoagulants (DOAC) provide clinicians with a valuable method for the  prevention and treatment of thrombotic events. However, DOAC also expose patients to the risk of bleeding or major bleeding, which can lead to major adverse events as a result of their inappropriate use. This article by Vornicu et al. highlights the various aspects that require consideration in order to minimise the incidence of these adverse events and points to the approaches available to ensure this can be done effectively. The article also provides important practical guidance in specific situations where DOAC are vulnerable to mismanagement.

Ovidiu Vornicu,1 Anne-Sophie Larock,2 Jonathan Douxfils,3 *François Mullier,3,4 Virginie Dubois,1 Jean-Michel Dogné,3 Maximilien Gourdin,1 Sarah Lessire,1,3 Anne-Sophie Dincq1

1. Université catholique de Louvain, CHU UCL Namur, Department of Anesthesiology, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute of Life Sciences (NARILIS), Yvoir, Belgium
2. Université catholique de Louvain, CHU UCL Namur, Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Yvoir, Belgium
3. Université de Namur, Department of Pharmacy, Namur Thrombosis and Hemostasis Center Namur (NTHC), Research Institute for Life Sciences (NARILIS), Namur, Belgium
4. Université catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Yvoir, Belgium
*Correspondence to mullierfrancois@gmail.com

Disclosure: The authors have declared no conflicts of interest. Sarah Lessire and Anne-Sophie Dincq contributed equally to the work.
Received: 29.02.16 Accepted: 14.06.16
Citation: EMJ Hematol. 2016;4[1]:78-90.

Abstract

Direct oral anticoagulants (DOAC) are used in several indications for the prevention and treatment of thrombotic events. As highlighted by data from clinical trials and case studies, all DOAC carry the risk of bleeding despite careful selection and patient management. Previous publications have demonstrated the limited knowledge of many physicians concerning the indications for, and correct management of, these anticoagulants. Health institutions should develop risk minimisation strategies and educational materials to prevent major adverse events related to DOAC administration. Major bleeding events are reported in clinical practice and specific antidotes are emerging from Phase III trials. Some antidotes are licensed but their high cost might limit routine use. We therefore illustrate approaches and tools that can help physicians prescribe DOAC appropriately. We focus on screening for modifiable bleeding risk factors and adapting doses according to the individual benefit-risk profile. We also provide recommendations on managing a missed dose, switching, bridging, and resumption.

Download (PDF, 260KB)

Comments are closed.