Management of bleeding associated with dabigatran and rivaroxaban: a survey of current practices

Abstract

Dabigatran and rivaroxaban are two new oral anticoagulants that have been recently approved as alternatives to warfarin. Clinical trials have shown non-inferiority of the new oral anticoagulants to warfarin for anti-thrombotic effects with equal to decreased bleeding risk. Unfortunately no standard method to assess the level of anticoagulation or reverse the effects of dabigatran or rivaroxaban is available. Current recommended management of bleeding patients taking dabigatran or rivaroxaban is based on expert opinion. To gain information from experience of physicians who have managed hemorrhaging patients, U.S. non-malignant hematologists were surveyed with a 31% response rate. In total, 43 cases of dabigatran associated hemorrhage and 5 cases of rivaroxaban associated bleeding were reported. Factor concentrates were used in 9 cases of dabigatran hemorrhage with perceived effectiveness ranging from 50-80%. A national registry is needed to track management of hemorrhages until antidotes become available.