![]() ![]() 2 Therefore, it is imperative to fully understand how to effectively manage bleeding complications that may arise from their use. 1ĭOACs offer several advantages over VKAs however, the risk of bleeding with these drugs should not be underestimated. In randomized clinical trials, all DOACs have demonstrated a reduced risk for intracranial hemorrhage, but major and nonmajor bleeding events have varied among the agents as compared with VKAs. ![]() DOACs include the direct thrombin inhibitor Pradaxa (dabigatran) and the factor Xa inhibitors Xarelto (rivaroxaban), Eliquis (apixaban), Savaysa (edoxaban), and, most recently, Bevyxxa (betrixaban). 1 These limitations led to the development of direct oral anticoagulants (DOACs). However, their use is limited by their narrow therapeutic index, the need for frequent blood monitoring, and numerous food and drug interactions. Vitamin K antagonists (VKAs), such as warfarin, have been the standard of care for treating thromboembolic diseases, having a relatively safe and effective profile. The use of specific agents for removal-idarucizumab, andexanet alfa, and ciraparantag (in development)-is discussed. Removal agents such as activated charcoal and hemodialysis also serve a role. Treatment options for managing bleeding associated with DOACs include nonspecific agents such as nonactivated prothrombin complex concentrate, activated prothrombin complex concentrate, recombinant activated factor VII, fresh frozen plasma, and antifibrinolytic agents. However, the risk of bleeding remains without adequate options for reversal. With no need for frequent blood monitoring and fewer drug and dietary interactions, DOACs present advantages over vitamin K antagonists. 2018 43(11)(Specialty&Oncology suppl):8-14.ĪBSTRACT: The use of direct oral anticoagulants (DOACs) in the treatment and prevention of thromboembolic disorders has become increasingly prevalent. ![]()
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