Vol. 12 No. 2 (2020): Archives of Public Health
Clinical Science

DOACs- balance between thrombosis and bleeding - A Review

Emilija Lazarova Trajkovska
University Clinic for Cardiology, Skopje, Republis of North Macedonia; Faculty of Medicine, Ss Cyril and Methodius University, Skopje, Republic of North Macedonia

Published 2020-07-16


  • reversal agents

How to Cite

Lazarova Trajkovska E. DOACs- balance between thrombosis and bleeding - A Review. Arch Pub Health [Internet]. 2020 Jul. 16 [cited 2022 Dec. 7];12(2):32-6. Available from: https://id-press.eu/aph/article/view/5192


Bleeding is a common side effect of anticoagulant use. However, the majority of bleeding events are not life-threatening and can be managed conservatively. The first step in managing any significant bleeding event is to temporarily stop using the anticoagulant. The aim of this review was to determine the appropriate management strategy for an acutely bleeding patient on DOACs.  Direct oral anticoagulants (DOACs) are now widely used in treatment of venous thromboembolism (VTE) and are recommended first-line over vitamin K antagonists (VKAs) in non-cancer associated VTE. Until recently, supportive measures and infusion of clotting factors were the only available options for reversal of DOACs. Within the last 4 years, approval of specific antidotes has led to hopes for improved outcomes in DOAC-related acute bleeding, however limitations remain including cost, availability and "real-world" data. In severe and life-threatening bleeding events, use of non-specific (e.g. PCC) or specific (e.g. idarucizumab, andexanet alpha) reversal agents are recommended. However, further data is needed to compare outcomes between these two management strategies and identify the cost-effectiveness of these various strategies.


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