GUIDELINES FOR THE MANAGEMENT OF HAEMORRHAGE IN PATIENTS WHO ARE UNDER P.OS ANTICOAGULANT THERAPY

Abstract

Anticoagulation is essential for the prevention of thromboembolic events, particularly in patients with atrial fibrillation and venous thromboembolism. Unavoidably, anticoagulant treatment also increases the risk of major and potentially life-threatening bleeding events. The approval and increasing use of the3 non-vitamin K-dependent oral anticoagulants, which directly inhibit thrombin or coagulation factor Xa, mandates the need for coordination and a consensus of all medical specialties involved in bleeding management, in order to provide clinicians with practical guidance and management algorithms. Beyond the first general measures aiming at controlling the hemorrhage and stabilizing the patient, specific management depends on the severity and localization of bleeding as well as the anticoagulant which the patient was receiving. Special emphasis is placed on the prevention of overuse and misuse of reversal agents for the new oral anticoagulants in emergency situations. Specific recommendations are provided for patients with intracranial or gastrointestinal bleeding, those with polytrauma, and patients under combined anticoagulant and antiplatelet treatment. The second part of the consensus document is dedicated to the assessment and management of the prioperative bleeding risk in both emergency and elective general surgery, vascular surgery, and in patients who are in need of thrombolytic treatment. Key words: Αnticoagulation, bleeding, vitamin K antagonists, new oral anticoagulants, direct oral anticoagulants, reversal agents, algorithms, perioperative management