Table of Contents Author Guidelines Submit a Manuscript
Erratum

An erratum for this article has been published. To view the erratum, please click here.

BioMed Research International
Volume 2014 (2014), Article ID 616405, 14 pages
http://dx.doi.org/10.1155/2014/616405
Review Article

Preventive Strategies against Bleeding due to Nonvitamin K Antagonist Oral Anticoagulants

1Department of Anesthesiology, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium
2Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), University of Namur, 5000 Namur, Belgium
3Department of Hematology, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium
4Department of Internal Medicine, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium
5Department of Pharmacy, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium
6Université Catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, 1200 Brussels, Belgium
7Hematology Laboratory, CHU Dinant-Godinne UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of Life Sciences (NARILIS), 5530 Yvoir, Belgium

Received 28 February 2014; Accepted 14 April 2014; Published 16 June 2014

Academic Editor: Helen Mani

Copyright © 2014 Lessire Sarah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Dabigatran etexilate (DE), rivaroxaban, and apixaban are nonvitamin K antagonist oral anticoagulants (NOACs) that have been compared in clinical trials with existing anticoagulants (warfarin and enoxaparin) in several indications for the prevention and treatment of thrombotic events. All NOACs presented bleeding events despite a careful selection and control of patients. Compared with warfarin, NOACs had a decreased risk of intracranial hemorrhage, and apixaban and DE (110 mg BID) had a decreased risk of major bleeding from any site. Rivaroxaban and DE showed an increased risk of major gastrointestinal bleeding compared with warfarin. Developing strategies to minimize the risk of bleeding is essential, as major bleedings are reported in clinical practice and specific antidotes are currently not available. In this paper, the following preventive approaches are reviewed: improvement of appropriate prescription, identification of modifiable bleeding risk factors, tailoring NOAC’s dose, dealing with a missed dose as well as adhesion to switching, bridging and anesthetic procedures.