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Treatment of bleeding complications in patients on anticoagulant therapy

Siavash Piran and Sam Schulman

Abstract

Anticoagulant therapy is often refrained from due to the 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 non-anticoagulated patients, as described here with the above-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 non-specific support for hemostasis with antifibrinolytic agents or prothrombin complex concentrates, which are widely available, should be kept in mind.

  • Submitted June 5, 2018.
  • Accepted September 18, 2018.