Preventive strategies against bleeding due to nonvitamin K antagonist oral anticoagulants

Sarah Lessire, Anne Sophie Dincq, Jonathan Douxfils, Bérangère Devalet, Jean Baptiste Nicolas, Anne Spinewine, Anne Sophie Larock, Jean Michel Dogné, Maximilien Gourdin, François Mullier

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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. © 2014 Lessire Sarah et al.

Original languageEnglish
Article number616405
JournalBioMed research international
Publication statusPublished - 2014


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