Abstract
The directly acting oral anticoagulants (DOAC), i. e. inhibitors of factor Xa (apixaban,
edoxaban and rivaroxaban) have gained increasing importance in the treatment and prophylaxis
of thromboembolic events. However, concerns have been raised about the possible bleeding
complications and the lack of antidots compared to the established vitamin k antagonists.
Regarding bleeding complications, recent data indicate a comparable to decreased incidence
of bleeding events in DOAC when compared to vitamin k antagonists. An antidote for
dabigatran is already available, antidotes for the other substances are currently
under development and investigation. We propose an individualized concept regarding
the diagnosis and treatment of DOAC-related bleeding event based on the local infrastructure
and patient collective. General measures including circulatory stabilization, volume
resuscitation, allogeneic transfusion and substitution of coagulation factors are
the basis of bleeding treatment. Specific aims including the use of antidotes are
especially important in moderate to severe bleeding complications.
