Blödning och kirurgi vid behandling med nya perorala antikoagulantia. Handläggningen kan kompliceras av att specifika antidoter saknas
Sammanfattning
Novel oral anticoagulants (NOAC; dabigatran, rivaroxaban, and apixaban) constitute alternatives to warfarin for stroke prophylaxis in patients with non-valvular atrial fibrillation, and in the prophylaxis and treatment of venous thromboembolism. Limited possibilities to monitor the effect of NOAC and lack of specific antidotes complicate the management of bleeding patients and in the perioperative setting. The risk of bleeding should be weighed against the increased thrombotic risk when considering withdrawal of NOAC or bridging with low molecular weight heparin. Due to the relatively short half-life of NOAC, discontinuing the drug and supportive therapy might be sufficient in many clinical situations. If possible, haemostatic expertise should be consulted when managing severe bleeds in patients treated with NOAC. Prothrombin complex concentrate treatment should be considered in case of severe bleeding, especially in patients treated with a factor Xa inhibitor, but this is not clinically documented and also entails an increased risk of thromboembolic complications.