Universität zu Köln

Grottke, O., Lier, H. and Hofer, S. (2017). Management of hemorrhage in patients treated with direct oral anticoagulants. Anaesthesist, 66 (9). S. 679 - 690. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1432-055X

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Abstract

The introduction of nonvitamin K antagonistic, direct oral anticoagulants (DOAC) made thromboembolic prophylaxis easier for patients. For many physicians, however, there is still uncertainty about monitoring, preoperative discontinuation, and restarting of DOAC therapy. Guidelines for the management of bleeding are provided, but require specific therapeutic skills in the management of diagnostics and therapy of acute hemorrhage. Small clinical studies and case reports indicate that unspecific therapy with prothrombin complex concentrates (PCC) and activated PCC (aPCC) concentrate may reverse DOAC-induced anticoagulation. However, PCC or aPCC at higher doses potentially provoke thromboembolic complications. However, idarucizumab, a specific, fast-acting, antidote for dabigatran, provides immediate and sustained reversal with no intrinsic or prohemostatic activity. This review article provides an overview of the pharmacology and potential risk of DOAC and the management in the perioperative period with a focus of current concepts in the treatment of DOAC-associated bleeding.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Grottke, O. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lier, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hofer, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-219811
DOI:	10.1007/s00101-017-0313-5
Journal or Publication Title:	Anaesthesist
Volume:	66
Number:	9
Page Range:	S. 679 - 690
Date:	2017
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1432-055X
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PROTHROMBIN COMPLEX CONCENTRATE; ATRIAL-FIBRILLATION; ANDEXANET ALPHA; REVERSAL AGENT; BLOOD-LOSS; DABIGATRAN; IDARUCIZUMAB; PORCINE; COAGULATION; WARFARIN Multiple languages Anesthesiology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/21981