Abstract
New direct oral anticoagulant drugs have been introduced in clinical practice for
prophylaxis and treatment of thromboembolic diseases. Despite the fact that these
new agents do have an improved benefit/risk/ratio as compared to vitamin K antagonists
mainly due to the reduction in severe and intercranial haemorrhages, bleeding complications
have to be expected and strategies for the management of bleeding and reversal of
anticoagulant effects will have to be developed.
Appropriate therapies for vitamin K antagonist associated bleeding included vitamin
K, fresh frozen plasma and prothrombin complex concentrates, but the optimal treatment
is still under investigation. For dabigatranetexilate, rivaroxaban and apixaban appropriate
therapies include local measures, observation and support, which will be effective
for the majority of patients due to the short half lives of these agents. If severe
and life treatening bleeding occure prothrombin complex concentrates or other clotting
factors substitutes may be appropriate, but evidence-based protocols specific to a
given agent are missing.
