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Year 2020, Volume: 3 Issue: 2, 62 - 65, 30.06.2020

Ozlem Koksal , Vahide Aslıhan Durak

Abstract

New generation oral anticoagulant (NOAC) drugs are widely used today, as they have more advantages in some clinical situations and they do not require close monitoring for their dosage.
Rarely, they increase the risk of bleeding like the other anticoagulant drugs and are not able to be monitored in the high dose intakes. Due to these reasons, the management of these patients in emergency department should be specific.
In this article, the emergency service management of patients with bleeding associated with the use of NOAC drugs will be discussed.

Keywords

New generation oral anticoagulants bleeding management emergency department

References

  • Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with two doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial. Circulation. 2011;123(21):2363-72.
  • Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361: 1139-1151.
  • Levine M, Goldstein JH. Bleeding complications of targeted oral anticoagulants. Hematology Am Soc Hematol Educ Program. 2014;1:504-509.
  • Levine M, Pizon AF, Padilla-Jones A, et al. Warfarin overdose: a 25 year experience. J Med Toxicol. 2014;10:156-164.
  • Pfeiffer H, Herbst L, Schwarze B, et al. Massive intoxication with rivaroxaban, phenprocoumon, and diclofenac: a case report. Medicine (Baltimore). 2016;95:e5343.
  • Repplinger DJ, Hoffman RS, Nelson LS, et al. Lack of significant bleeding despite large acute rivaroxaban overdose confirmed with whole blood concentrations. Clin Toxicol. 2016;54:647-649.
  • Lehmann T, Hofer KE, Baumann M, et al. Massive human rivaroxaban overdose. Thromb Haemost. 2014;112:834-836.
  • Sajkov D, Gallus A. Accidental rivaroxaban overdose in a patient with pulmonary embolism: some lessons for managing new oral anticoagulants. Clin Med Insights Case Rep. 2015;8:57-59.
  • Barton J, Wong A, Graudins A. Anti-X activity in apixaban overdose: a case report. Clin Toxicol (Phila). 2016;54:871-873.
  • Peetermans M, Pollack CJr, Reilly P, et al. Idarucizumab for dabigatran overdose. Clin Toxicol (Phila). 2016;54:644-646.
  • Shapiro S, Bhatnagar N, Khan A, et al. Idarucizumab for dabigatran overdose in a child. Br J Haematol. 2018;180(3):457-459. doi: 10.1111/bjh.14371.
  • Vlad I, Armstrong J, Ridgley J, et al. Dabigatran deliberate overdose: two cases and suggestions for laboratory monitoring. Clin Toxicol (Phila). 2016;54:286-289.
  • Mumoli N, Cei M, Fiorini M, et al. Conservative management of intentional massive dabigatran overdose. Blood Coagul Fibrinolysis. 2015;26:225-229.
  • Chiew AL, Khamoudes D, Chan BS, et al. Use of continuous veno- venous haemodiafiltration therapy in dabigatran overdose. Clin Toxicol (Phila). 2014;52:283-287.
  • Woo JS, Kapadia N, Phanco SE, et al. Positive outcome after intentional overdose of dabigatran. J Med Toxicol. 2013;9:192-195.
  • Kocabay G, Okcular I, Akkaya V, et al. Suicide attempt with clopidogrel. Hum Exp Toxicol. 2006;25:731-734.
  • Michael Levine, Michael C. Beuhler, et al. Assessing Bleeding Risk in Patients With Intentional Overdoses of Novel Antiplatelet and Anticoagulant Medications. Annals of Emergency Medicine. 2018;71(3): 273-8.
  • Majeed A, Schulman S. Bleeding and antidotes in new oral anticoagulants. Best Practice & Research Clinical Haematology. 2013; 26:191-202.
  • https://www.uptodate.com/contents/direct-oral-anticoagulants-and-parenteral-direct-thrombin-inhibitors-dosing-and-adverse-effects?search=new%20anticoagulants&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
  • Goldfrank's Toxicologic Emergencies.pdf. 2015. Betty C Chen, Marc Su. Chapter 60: Antithrombotics, 1383-1395.
  • Harder S, Graff J. Novel oral anticoagulants: clinical pharmacology, indications and practical considerations. Eur J Clin Pharmacol. 2013;69:1617-33.
  • Gomez-Outes A, Suarez-Gea ML, Lecumberri R et al. Direct-acting oral anticoagulants: pharmacology, indications, management, and future perspectives. Eur J Haematol. 2015;19:389-404. doi:10.1111/ejh.12610.
  • Liew A, Eikelboom JW, O’Donnel M, et al. Assesment of Anticoagulation Intensity and Management of Bleeding With Old and New Oral Anticoagulants. Canadian Journal of Cardiology 29 (2013) S34eS44
  • Warkentin TE, Greinacher A, Koster A. Bivalirudin. ThrombHaemost 2008; 99:830.
  • Swan SK, Hursting MJ. The pharmacokinetics and pharmacodynamics of argatroban: effects of age, gender, and hepatic or renal dysfunction. Pharmacotherapy 2000; 20:318.
  • Graetz TJ, Tellor BR, Smith JR, et al. Desirudin: a review of the pharmacology and clinical application for the prevention of deep vein thrombosis. ExpertRevCardiovascTher 2011; 9:1101.
  • https://www.uptodate.com/contents/risks-and-prevention-of-bleeding-with-oral-anticoagulants?search=edoxaban&topicRef=1370&source=see_link
  • Protrombin Kompleks Konsantresi (PCC), Editör: Y.Çete, Medical Network. S:45-58.
  • Cuker A, Burnett A, Triller D, et al. Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum. Am J Hematol. 2019 Jun;94(6):697-709. doi: 10.1002/ajh.25475
  • Vlad I, Armstrong J, Ridgley J, et al. Dabigatran deliberate overdose: two cases and suggestions for laboratory monitoring. Clinical Toxicolog, 2016 Vol. 54, No. 3, 286–289. doi.org/10.3109/15563650.2015.1126287

Yeni Kuşak Oral Antikoagülanlara Bağlı Kanamalarda Acil Servis Yönetimi

Year 2020, Volume: 3 Issue: 2, 62 - 65, 30.06.2020

Ozlem Koksal , Vahide Aslıhan Durak

Abstract

Bazı klinik durumlarda avantajlı oldukları ve dozları açısından yakın izlem gerektirmedikleri için yeni kuşak oral antikoagülan (YOAK) ilaçlar günümüzde yaygın olarak kullanılmaktadır.

Nadir de olsa tüm antikoagülan ilaçlar gibi kanama riskini arttırırlar ve yüksek doz maruziyetlerinde laboratuvar olarak monitörizasyonları mümkün değildir. Bu yüzden hastaların acil serviste yönetimi özellik arz etmektedir.

Bu yazıda YOAK kullanımına bağlı kanamalı hastaların acil servis yönetiminden bahsedilecektir.

Keywords

Yeni kuşak oral antikoagülan acil servis kanama yönetim

References

  • Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with two doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial. Circulation. 2011;123(21):2363-72.
  • Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361: 1139-1151.
  • Levine M, Goldstein JH. Bleeding complications of targeted oral anticoagulants. Hematology Am Soc Hematol Educ Program. 2014;1:504-509.
  • Levine M, Pizon AF, Padilla-Jones A, et al. Warfarin overdose: a 25 year experience. J Med Toxicol. 2014;10:156-164.
  • Pfeiffer H, Herbst L, Schwarze B, et al. Massive intoxication with rivaroxaban, phenprocoumon, and diclofenac: a case report. Medicine (Baltimore). 2016;95:e5343.
  • Repplinger DJ, Hoffman RS, Nelson LS, et al. Lack of significant bleeding despite large acute rivaroxaban overdose confirmed with whole blood concentrations. Clin Toxicol. 2016;54:647-649.
  • Lehmann T, Hofer KE, Baumann M, et al. Massive human rivaroxaban overdose. Thromb Haemost. 2014;112:834-836.
  • Sajkov D, Gallus A. Accidental rivaroxaban overdose in a patient with pulmonary embolism: some lessons for managing new oral anticoagulants. Clin Med Insights Case Rep. 2015;8:57-59.
  • Barton J, Wong A, Graudins A. Anti-X activity in apixaban overdose: a case report. Clin Toxicol (Phila). 2016;54:871-873.
  • Peetermans M, Pollack CJr, Reilly P, et al. Idarucizumab for dabigatran overdose. Clin Toxicol (Phila). 2016;54:644-646.
  • Shapiro S, Bhatnagar N, Khan A, et al. Idarucizumab for dabigatran overdose in a child. Br J Haematol. 2018;180(3):457-459. doi: 10.1111/bjh.14371.
  • Vlad I, Armstrong J, Ridgley J, et al. Dabigatran deliberate overdose: two cases and suggestions for laboratory monitoring. Clin Toxicol (Phila). 2016;54:286-289.
  • Mumoli N, Cei M, Fiorini M, et al. Conservative management of intentional massive dabigatran overdose. Blood Coagul Fibrinolysis. 2015;26:225-229.
  • Chiew AL, Khamoudes D, Chan BS, et al. Use of continuous veno- venous haemodiafiltration therapy in dabigatran overdose. Clin Toxicol (Phila). 2014;52:283-287.
  • Woo JS, Kapadia N, Phanco SE, et al. Positive outcome after intentional overdose of dabigatran. J Med Toxicol. 2013;9:192-195.
  • Kocabay G, Okcular I, Akkaya V, et al. Suicide attempt with clopidogrel. Hum Exp Toxicol. 2006;25:731-734.
  • Michael Levine, Michael C. Beuhler, et al. Assessing Bleeding Risk in Patients With Intentional Overdoses of Novel Antiplatelet and Anticoagulant Medications. Annals of Emergency Medicine. 2018;71(3): 273-8.
  • Majeed A, Schulman S. Bleeding and antidotes in new oral anticoagulants. Best Practice & Research Clinical Haematology. 2013; 26:191-202.
  • https://www.uptodate.com/contents/direct-oral-anticoagulants-and-parenteral-direct-thrombin-inhibitors-dosing-and-adverse-effects?search=new%20anticoagulants&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
  • Goldfrank's Toxicologic Emergencies.pdf. 2015. Betty C Chen, Marc Su. Chapter 60: Antithrombotics, 1383-1395.
  • Harder S, Graff J. Novel oral anticoagulants: clinical pharmacology, indications and practical considerations. Eur J Clin Pharmacol. 2013;69:1617-33.
  • Gomez-Outes A, Suarez-Gea ML, Lecumberri R et al. Direct-acting oral anticoagulants: pharmacology, indications, management, and future perspectives. Eur J Haematol. 2015;19:389-404. doi:10.1111/ejh.12610.
  • Liew A, Eikelboom JW, O’Donnel M, et al. Assesment of Anticoagulation Intensity and Management of Bleeding With Old and New Oral Anticoagulants. Canadian Journal of Cardiology 29 (2013) S34eS44
  • Warkentin TE, Greinacher A, Koster A. Bivalirudin. ThrombHaemost 2008; 99:830.
  • Swan SK, Hursting MJ. The pharmacokinetics and pharmacodynamics of argatroban: effects of age, gender, and hepatic or renal dysfunction. Pharmacotherapy 2000; 20:318.
  • Graetz TJ, Tellor BR, Smith JR, et al. Desirudin: a review of the pharmacology and clinical application for the prevention of deep vein thrombosis. ExpertRevCardiovascTher 2011; 9:1101.
  • https://www.uptodate.com/contents/risks-and-prevention-of-bleeding-with-oral-anticoagulants?search=edoxaban&topicRef=1370&source=see_link
  • Protrombin Kompleks Konsantresi (PCC), Editör: Y.Çete, Medical Network. S:45-58.
  • Cuker A, Burnett A, Triller D, et al. Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum. Am J Hematol. 2019 Jun;94(6):697-709. doi: 10.1002/ajh.25475
  • Vlad I, Armstrong J, Ridgley J, et al. Dabigatran deliberate overdose: two cases and suggestions for laboratory monitoring. Clinical Toxicolog, 2016 Vol. 54, No. 3, 286–289. doi.org/10.3109/15563650.2015.1126287
There are 30 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Review
Authors

Ozlem Koksal 0000-0003-2271-5659

Vahide Aslıhan Durak 0000-0003-0836-7862

Publication Date June 30, 2020
Published in Issue Year 2020 Volume: 3 Issue: 2

Cite

AMA Koksal O, Durak VA. Yeni Kuşak Oral Antikoagülanlara Bağlı Kanamalarda Acil Servis Yönetimi. Anatolian J Emerg Med. June 2020;3(2):62-65.
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ISSN: 2651-4311

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