Emergency care of patients receiving non-vitamin K antagonist oral anticoagulants

J W Eikelboom; S Kozek-Langenecker; A Exadaktylos; A Batorova; Z Boda; F Christory; I Gornik; G Kėkštas; A Kher; R Komadina; O Koval; G Mitic; T Novikova; E Pazvanska; S Ratobilska; J Sütt; A Winder; D Zateyshchikov

doi:10.1016/j.bja.2017.11.082

Emergency care of patients receiving non-vitamin K antagonist oral anticoagulants

Br J Anaesth. 2018 Apr;120(4):645-656. doi: 10.1016/j.bja.2017.11.082. Epub 2017 Dec 1.

Authors

J W Eikelboom¹, S Kozek-Langenecker², A Exadaktylos³, A Batorova⁴, Z Boda⁵, F Christory⁶, I Gornik⁷, G Kėkštas⁸, A Kher⁹, R Komadina¹⁰, O Koval¹¹, G Mitic¹², T Novikova¹³, E Pazvanska¹⁴, S Ratobilska¹⁵, J Sütt¹⁶, A Winder¹⁷, D Zateyshchikov¹⁸

Affiliations

¹ Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada. Electronic address: [email protected].
² Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria.
³ Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
⁴ Department of Haematology and Transfusion Medicine, Faculty of Medicine of Comenius University, and University Hospital, Bratislava, Slovakia.
⁵ Department of Internal Medicine, Thrombosis and Haemostasis Centre, University of Debrecen, Debrecen, Hungary.
⁶ Medical Education Global Solutions, Paris, France.
⁷ Intensive Care Unit, Department of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia.
⁸ Department of Anaesthesiology and Intensive Care, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania.
⁹ Laboratory of Biological Hematology, Hôtel-Dieu University Hospital, Paris, France.
¹⁰ Department of Traumatology, General and Teaching Hospital Celje, Celje, Slovenia.
¹¹ Department of Hospital Therapy No. 2, Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine.
¹² Thrombosis and Haemostasis Unit, Centre of Laboratory Medicine, Clinical Centre of Vojvodina, and Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
¹³ Department of Cardiology, Northwestern Medical University I. I. Mechnikov, and Vascular Centre, Pokrovskaya City Hospital, Saint Petersburg, Russian Federation.
¹⁴ Department Anaesthesia and Intensive Care, 4th City Hospital, Sofia, Bulgaria.
¹⁵ Intensive Care Unit, Pauls Stradins Clinical University Hospital, Riga, Latvia.
¹⁶ Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia.
¹⁷ Department of Hematology, Thrombosis and Hemostasis Unit, Wolfson Medical Center, Holon, Israel.
¹⁸ Primary Vascular Department, City Clinical Hospital No. 51, Moscow, Russia.

PMID: 29576106
DOI: 10.1016/j.bja.2017.11.082

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, edoxaban) have been introduced in several clinical indications. Although NOACs have a favourable benefit-risk profile and can be used without routine laboratory monitoring, they are associated-as any anticoagulant-with a risk of bleeding. In addition, treatment may need to be interrupted in patients who need surgery or other procedures. The objective of this article, developed by a multidisciplinary panel of experts in thrombosis and haemostasis, is to provide an update on the management of NOAC-treated patients who experience a bleeding episode or require an urgent procedure. Recent advances in the development of targeted reversal agents are expected to help streamline the management of NOAC-treated patients in whom rapid reversal of anticoagulation is required.

Keywords: anticoagulants; coagulation monitoring; emergencies; haemorrhage; reversal.

Publication types

Review

MeSH terms

Administration, Oral
Anticoagulants / adverse effects*
Antithrombins / adverse effects*
Emergency Medical Services / methods*
Hemorrhage / chemically induced*
Hemorrhage / therapy*
Humans

Substances

Anticoagulants
Antithrombins