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Management of Severe Bleeding in Patients Treated with Direct Oral Anticoagulants

2017; Lippincott Williams & Wilkins; Volume: 127; Issue: 1 Linguagem: Inglês

10.1097/aln.0000000000001631

1528-1175

Jessica Dennis, Alejandra Medina-Rivera, Vinh Trương, Lina Antounians, Nora Zwingerman, Giovana Carrasco, Lisa Strug, Philip S. Wells, France Trégouët, France Morange, M Wilson, France Gagnon, Pierre Albaladejo, Marc Samama, Piérre Siè, Sophie Kauffmann, Vincent Mémier, Pierre Suchon, Alain Viallon, Jean David, Y Gruel, Lorenn Bellamy, Emmanuel de Maistre, Pauline Romegoux, Sophie Thoret, Gilles Pernod, Jean-Luc Bosson, E. V. Bazin, Nicolas Combaret, A.‐L. CHERPRENET, Moustafa Fares, Sophie Dufraisse, Vincent Minville, Pierre‐Emmanuel Morange, Marc Léone, William Cohen, Nadège Néant, Raphaël Marlu, Françoise Carpentier, Pascal Defaye, Patrick Mismetti, Serge Molliex, Julien Lanoiselée, Vincent Piriou, Carine Delaleu-Rague, M. Lefèvre, Sophie Lagrange, L. Ardillon, Yves Ozier, Julien Bovet, A. Steib, Sonia Mebaouj, Louis Profumo, Stéphanie Roullet, David M. Smadja, Guy Meyer, Didier Journois, Albert Trinh-Duc, Thibault Viard, Loïc Belle, Albrice Levrat, Etienne Gautheron, Frédéric Heluwaert, S. Schlumberger, Antonia Blanié, Dan Benhamou, Claire Flaujac, Nadia Rosencher, Hélène Beloeil, Catherine Blery, Lauren Daviet, Pierre Guéret, David Faraoni, Jean‐François Schved, Pauline Deras, Samir Jaber, Pierre Yves Gueugniaud, Bernard Floccard, Karim Asehnoune, Jérôme Paulus, Omar Amrani, Marie Caroline Gonthier, Marie Geneviève Huisse, Julien Josserand, Emmanuelle de Raucourt, Cécile Defournel, Yohann Dubois, S. Bouvier, P.M. Roy, Sigismond Lasocki, Christian Carmagnac, Catherine Chastagner, J.M. Thouret, M.-A. Sevestre, Eric Meaudre, Pierre‐Julien Cungi, Sophie Susen, Jean Yves Lefrant, Stéphane Macey, J. Rieu, Anne Godiér,

Acute Myocardial Infarction Research

The use of prothrombin complex concentrates and the role of plasma concentration of anticoagulants in the management of bleeding in patients treated with direct oral anticoagulants are still debated. Our aim was to describe management strategies and outcomes of severe bleeding events in patients treated with direct oral anticoagulants.We performed a prospective cohort study of 732 patients treated with dabigatran, rivaroxaban, or apixaban hospitalized for severe bleeding, included prospectively in the registry from June 2013 to November 2015.Bleeding was gastrointestinal or intracranial in 37% (212 of 732) and 24% (141 of 732) of the cases, respectively. Creatinine clearance was lower than 60 ml/min in 61% (449 of 732) of the cases. The plasma concentration of direct oral anticoagulants was determined in 62% (452 of 732) of the cases and was lower than 50 ng/ml or higher than 400 ng/ml in 9.2% (41 of 452) and in 6.6% (30 of 452) of the cases, respectively. Activated or nonactivated prothrombin complex concentrates were administered in 38% of the cases (281 of 732). Mortality by day 30 was 14% (95% CI, 11 to 16).Management of severe bleeding in patients treated with direct oral anticoagulants appears to be complex. The use of prothrombin complex concentrates differs depending on bleeding sites and direct oral anticoagulant plasma concentrations. Mortality differs according to bleeding sites and was similar to previous estimates.