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Clinical Articles, News & Views

New oral anticoagulants and bleeding management

As new oral anticoagulants (NOACs) are being prescribed with increasing frequency, and patients are fully anticoagulated, although the risk of intracranial bleeding is reduced, there is still a risk of major haemorrhage. An article by Dr Raza Alikhan (University Hospital of Wales, Cardiff), published in the British Journal of Cardiology,1 provides an understanding of the metabolism and excretion of NOACs, as well as their effects on coagulation tests, which is paramount in the management of patients, particularly in emergency situations.

The key points of the article are:

  • New oral direct inhibitors offer a number of advantages over warfarin, but patients are therapeutically anticoagulated and remain at risk of bleeding
  • Dabigatran is a direct thrombin inhibitor, and will prolong the activated partial thromboplastin time (aPTT) and thrombin time (TT) to a varying degree: plasma concentration is measured by a dilute TT
  • Apixaban and rivaroxaban are direct inhibitors of activated factor X, and will prolong the prothrombin time (PT) (and aPTT) to a varying degree: plasma concentration is measured by an anti-Xa assay (with appropriate calibrators)
  • Management of bleeding for the majority of patients is supportive

The article can be read in full at http://dx.doi.org/10.5837/bjc.2014.009

References

1. Alikhan R. The new oral anticoagulants and management of bleeding. Br J Cardiol 2014;21:69–71. http://dx.doi.org/10.5837/bjc.2014.009

Published on: June 26, 2014

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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