A promising strategy to control life-threatening bleeding

Av Vania Morelli
Forsker ved TREC

Anticoagulants, commonly referred to as blood thinners, are drugs used to prevent the

formation of blood clots in the blood vessels or in the heart. A new generation of drugs, the so-called direct oral anticoagulants (DOACs), has emerged as an interesting alternative to warfarin, a well-known anticoagulant by clinicians, for oral anticoagulation. A new study searched for a therapeutic strategy to manage life-threatening bleeding in patients who use DOACs.

As anticoagulants prevent the formation of clots by reducing blood coagulation, bleeding can be a serious complication during treatment with these drugs. While there are established and effective therapeutic strategies for bleeding in patients receiving warfarin, there is still considerable uncertainty on how to manage bleeding related to DOACs, such as rivaroxaban and apixaban. Recently, Majeed and colleagues published a study in Blood that shed more light on the management of bleeding in patients treated with rivaroxaban and apixaban, which are inhibitors of the activity of factor X in blood coagulation.

In this study conducted in Sweden, 84 patients with life-threatening bleeding while on rivaroxaban or apixaban were managed with prothrombin complex concentrate (PCC). The goal of PCC is to provide additional coagulation factors, thereby allowing the anticoagulant effect induced by rivaroxaban or apixaban to be overcome. Assessment of the effectiveness of PCC treatment was done according to criteria established by the International Society of Thrombosis and Hemostasis’ Scientific and Standardization Subcommittee.

Treatment with PCC was assessed as effective in 58 patients, which corresponded to 69% of the patients. One of the possible complications after treatment with PCC are thromboembolic events – clots causing trouble in another place than it’s origin – which occurred in 3 patients. Twenty-seven patients, that is 32%, died within 30 days after the bleeding event. The cause of death in all these cases was assessed as not related to treatment with PCC, possibly with the exception of one patient. The authors concluded that administration of PCC for management of life-threatening bleeding associated with rivaroxaban or apixaban is effective in most cases and associated with a low risk of thromboembolic events.

Findings from this study provide valuable data for clinicians to treat bleeding complications associated with rivaroxaban and apixaban, and form the basis for further studies on this relevant clinical topic.

Reference: Majeed A, Ågren A, Holmström M, Bruzelius M, Chaireti R, Odeberg J, Hempel EL, Magnusson M, Frisk T, Schulman S. Management of rivaroxaban or apixaban associated major bleeding with prothrombin complex concentrates: a cohort study. Blood (2017).

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