Management of Bleeding Complications

Abstract

The most important adverse effect of antithrombotic treatment is the occurrence of bleeding. Studies of patients receiving anticoagulant therapy indicate that the incidence of major bleeding is 0.5 %/year and intracranial bleeding 0.2 %/year, however, it is likely that in real life practice the incidence is even higher. In particular, combined anticoagulant and antiplatelet agents may markedly increase the risk of major hemorrhagic complications. The most important risk factors for bleeding in patients receiving anticoagulants are the intensity of the anticoagulation and some patient characteristics, including age and co-morbidities. In case of serious or even life-threatening bleeding in a patient who uses anticoagulant agents or when a patient on anticoagulants needs to undergo an urgent invasive procedure, anticoagulant treatment can be reversed by various specific strategies. Heparin and heparin derivatives can be counteracted by protamine sulphate, whereas the anticoagulant effect of vitamin K antagonists may be neutralized with the administration of vitamin K or prothrombin complex concentrates. The anti-hemostatic effect of aspirin and other anti-platelet agents can be corrected by the administration of platelet concentrate and/or desmopressin, if needed. For the new generation oral anticoagulants including specific inhibitors of factor IIa, or factor Xa reversing strategies are currently being evaluated. The effect of factor Xa inhibitors can probably be reversed by prothrombin complex concentrates or recombinant factor VIIa, whereas for anti-IIa agents no specific reversing agent has been identified so far.