Therapeutic approach to the bleeding in association with “old” and “new” anticoagulants

Czech version

Authors: P. Ďulíček
Authors‘ workplace: Oddělení klinické hematologie II. interní kliniky Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc.
Published in: Vnitř Lék 2012; 58(7 a 8): 123-127
Category: 60th Birthday prof. MUDr. Miroslav Penka, CSc.

Overview

There are a several new anticoagulants emerging in the clinical medicine in the last a few years. Rivaroxaban, an oral direct F Xa inhibitor has been already approved in more than 100 countries worldwide, and Dabigatran etexilate, an oral direct thrombin inhibitor is also routinely used in thromboprophylaxis of venous thromboembolism. These agents possess many of the characteristic of the “ideal” anticoagulant but a lack of specific antidotes may be a potentional disadvantage in the therapy of bleeding complications. We assume, this lack of antidote does not represent a significant problem. In comparison with established anticoagulants (unfractionated heparin – UFH, low molecular weight heparin – LMWH, vitamin K antagonists – VKAs), only UFH has a specific and affective reversal agent. LMWH does not have the full proven antidote and the reversal agents recommended for the effects of VKAs have several safety and practical limitations. In the article we propose the basic principles of the management of bleeding complications in association with the newer anticoagulans. To manage bleeding episodes, we recommend delaying the next dose or discontinuing of treatment, mechanical compression, surgical interventions and the administration of the blood products. In the case of life-threatening bleeding, Novosen – rF VII is indicated.

Key words:
rivaroxaban – dabigatran – bleeding – therapy

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