Bleeding in patients on anticoagulant therapy: the real utility of antidotes and how to manage bleeding in patients on new-generation oral anticoagulants

Bleeding is one of the most feared complications of anticoagulant therapy. Discontinuing

the anticoagulant and establishing of support measures will often resolve the emergency,

but some cases require more specific treatment. Vitamin K antagonists (VKAs) have

traditionally been used for long-term prevention of thromboembolic complications, but

these drugs have many limitations that complicate clinical management. The newgeneration

of oral anticoagulants are similar in efficacy to VKAs but are associated with a

lower incidence of intracranial hemorrhage, do not require routine scheduling of

laboratory tests, and can be prescribed at fixed dosages. However, these drugs are not

complication-free. The management of acute bleeding is very similar for patients on

either VKA or a new oral anticoagulant, with the single exception that a specific antidote

is available to reverse the effect of a VKA.