Treatment with DOACs should be discontinued if severe bleeding occurs.ĭOACs interact with a number of medicines, some of which increase bleeding risk. Bleeding can occur at any site during treatment with DOACs. Although routine anticoagulant monitoring is not required for DOACs as it is for vitamin K antagonists, patients (particularly those with an increased bleeding risk) should be made aware of the risk of bleeding and be routinely examined clinically for signs of bleeding or anaemia. In many reported cases, patients have underlying factors that suggest they are at increased risk of bleeding events.įor this reason, DOACs should be used with caution in patients at increased risk of bleeding such as older people and patients with low body weight or renal impairment. We continue to receive reports of bleeds, often life-threatening or fatal, in association with DOACs in patients in the UK. Use of DOACs increases the risk of bleeding and can cause serious, potentially fatal, bleeds. Available DOACs include the direct factor Xa inhibitors apixaban ( Eliquis), edoxaban ( Lixiana▼), and rivaroxaban ( Xarelto▼) and the direct thrombin inhibitor dabigatran etexilate ( Pradaxa). Report suspected adverse drug reactions associated with DOACs on a Yellow Card, including thromboembolic or haemorrhagic eventsĭirect-acting oral anticoagulants (DOACs) are approved for a variety of uses related to anticoagulation (see full indications in further information section). Monitor the reversal effects of andexanet alfa using clinical parameters anti-FXa assays should not be used to measure the effectiveness of andexanet alfa as the results may not be reliable Specific DOAC reversal agents are available for dabigatran, apixaban, and rivaroxaban
Remind patients of the signs and symptoms of bleeding and encourage them to always read the patient information leaflet that accompanies their medicinesĮnsure patients with renal impairment receive an appropriate dose (see advice below) and monitor renal function during treatment to ensure dose remains appropriate Remain vigilant for signs and symptoms of bleeding complications during treatment, especially patients with increased bleeding risk Use caution if prescribing direct-acting oral anticoagulants (DOACs) to patients at increased risk of bleeding (for example, older people or people with renal impairment)
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