Oral Anticoagulation and the Novel Oral Anticoagulants (NOACs):Where Are We at Midterm?

Academic Content

Program Overview

Faculty Presentations

Introduction Deepak L. Bhatt Elaine Hylek

Video Roundtable

Current Activity

Elaine Hylek, MD, MPH, Boston University School of Medicine, Boston, Massachusetts

NOACs in Clinical Care NOACS Prevention Data NOACS: Major Bleeding Meta-Analysis ESC 2012 Guidelines Update Garfield Registry Prophylaxis vs Anticoagulation Clinical Trial: Major Bleeding Benefit and Risk Bleeding Risk Score Consensus Statements CHA2DS2-VASc Bleeding Risk Score Circulation Article Patient Age vs TTR NOACs vs Warfarin NOACS & Renal Dysfunction EHRA NOACs Practical Guide Procedural Management NOACs Bleeding Management Life-threatening Hemorrhage CAT Scans of Cerebral Hemorrhage Intracerebral Hemorrhage: Limited Data Kcentra: FDA approval Safety: Meta-analysis Anticoagulation Antidotes Dose Differences: AFib vs VTE NOACS in Clinical Practice Continuing role for warfarin?

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Life-threatening Hemorrhage

What about cases of life-threatening bleeding in patients on one of the NOACs? The 2 potential reversal agents here are prothrombin complex concentrates (PCCs) or recombinant factor VIIa, although it appears that most physicians in this field are moving toward the PCCs for life-threatening bleeding.[14]

As seen in Figure 21, the EHRA guidelines also prefer the PCCs.[14] These will be familiar to the hospital pharmacist or hematologist, who will know what these are and how to use them, and who can provide assistance in cases where a physician is confronted with a patient with a life-threatening bleed on one of the NOACs. Such a presentation will no doubt be unusual, but physicians must be alert to the possibility and understand how to use these reversal agent choices.

Hylek EM. Am J Med 2014; 00.

References

[14]

Heidbuchel H, Verhamme P, Alings M, et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651.