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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Safety of Prothrombin Complex Concentrates for Rapid Reversal of Anticoagulation with Vitamin K Antagonists: A Meta-analysis

Another caveat: a word of caution about embracing this 4-factor PCC for all bleeds. It should be reserved for individuals with truly life-threatening or severe hemorrhage. That is because it can actually cause thrombosis. This does not happen very often, but in the meta-analysis of 27 studies, reviewed in Figure 25, the overall rate of thrombotic events (including pulmonary embolisms, myocardial infarctions, and stroke) was about 1.4%.[18]

Certainly faced with a severe hemorrhage that is threatening a patient's life, the healthcare giver is going to do whatever possible to stop the bleed, but the physician should still realize that with PCCs there is a small risk of thrombosis.

Hylek EM. Am J Med 2014; 00.

References

[18]

Crowther M, Mathur V, Kitt M, et al. A Phase 2 randomized, double-blind, placebo-controlled trial demonstrating reversal of rivaroxaban-induced anticoagulation in healthy subjects by andexanet alfa (PRT064445), an antidote for FXa inhibitors. Blood. 2013;122:3636.