New direct oral anticoagulants – current therapeutic options and treatment recommendations for bleeding complications

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245

Theme Issue
MicroRNAs in vascular biology: Circulating miRNAs

Issue: 2012: 108/4 (Oct) pp. 589-800
Pages: 625-632

New direct oral anticoagulants – current therapeutic options and treatment recommendations for bleeding complications

W. Miesbach (1), E. Seifried (2)

(1) Medical Clinic III, Institute of Transfusion Medicine, University Hospital, Frankfurt/Main, Germany; (2) Institute of Transfusion Medicine and Immunohaematology, DRK-Red Cross, University Hospital, Frankfurt/Main, Germany


bleeding complication, oral anticoagulant, treatment recommendation, Prophylactic anticoagulation


To date, clinical studies show that the incidence of spontaneous bleeding with new direct oral anticoagulants (DOAs) is comparable to that of established anticoagulants. However, unlike vitamin K antagonists, there are currently no clinically available antidotes or approved reversal agents for new DOAs. Restoring normal coagulation is important in many cases, such as emergency surgeries, serious bleedings, or anticoagulant overdosing. Attempts have been made to restore normal coagulation after treatment with new DOAs using compounds such as recombinant activated factor VII (rFVIIa), prothrombin complex concentrate (PCC), or FEIBA (factor eight inhibitor bypassing activity). Limited pre-clinical data and even less clinical evidence are available on the usefulness of these methods in restoring normal coagulation for the emergency management of critical bleeding episodes. Evaluating the utility of DOAs is further complicated by the fact that it is unknown how predictive established test systems are of the bleeding risks. Clinical practice requires further evaluation of the emergency management options for the new DOAs to define the agents and the doses that are most useful. Furthermore, patients receiving long-term treatment with a DOA are likely to undergo elective surgery at some point, and there is lack of evidence regarding perioperative treatment regimens under such conditions. This review summarises potential bleeding management options and available data on the new DOAs.

You may also be interested in...

Bart J. Biemond 1, Elisabeth Perzborn 2, Philip W. Friederich 3, Marcel Levi 3, Ulf Buetehorn 4, Harry R. Büller3

Thromb Haemost 2007 97 3: 471-477

Wolfgang Wienen 1, Jean-Marie Stassen 2, Henning Priepke 1, Uwe Joerg Ries 1, Norbert Hauel1

Thromb Haemost 2007 98 1: 155-162


W. Gaus1 , J. Westendorf2 , R. Diebow3 , M. Kieser 3

Methods Inf Med 2005 44 5: 697-703