Strategies are available to stop or reduce bleeding when patients are on anticoagulants
- NOACs have the advantage of short half-lives compared to VKAs,,,,,,,,
- In the majority of bleeding events, standard clinical measures allow the bleed to be stopped,,,,,,,
- In the rare case of a life-threatening bleed, the priority is to save the patient by rapidly applying universal bleeding management strategies. According to the latest international guidelines non-specific broadly active reversal agents like PCC should be considered and specific reversal agents, if available.
Bleeding Management of Xarelto®
__________
The following recommendations reflect current published clinical trials, consensus publications, regulatory statements and the growing clinical experience with Xarelto, which now includes treatment of over 66.1 million patients worldwide, across 7 licensed indications.*,,
Recommended strategies for the management of bleeding events
___________
FFP, fresh frozen plasma; PCC, prothrombin complex concentrate; rFVIIa, recombinant factor VIIa.
General management of acute bleeding
__________
Individualise according to the severity and location of the haemorrhage.
Delay or discontinue ongoing treatment with Xarelto,
Employ symptomatic treatment measures, appropriate to bleed severity:
- Mechanical compression
- Surgical haemostasis with bleeding-control procedures
- Fluid replacement and haemodynamic support
- Blood products (packed red cells and or fresh frozen plasma)
Severe, life-threatening bleed-management recommendation
__________
In the rare case of a life-threatening bleed, the priority is to save the patient by rapidly applying universal bleeding management strategies. According to the latest international guidelines non-specific broadly active reversal agents like PCC should be considered and specific reversal agents, if available.
Managing overdose of Xarelto,
__________
Activated charcoal may be helpful to reduce absorption if used within 2 hours of suspected overdose.
Due to high protein binding, dialysis is ineffective.
If overdose is accompanied by bleeding, the general management methods above should be followed.
Once bleeding has ceased
__________
Re-assess thrombotic risk and restart Xarelto at the relevant dose when appropriate.
* Calculation based on IQVIA MIDAS Database: Quarterly Sales Q4 2019.
PP-XAR-ALL-1806-1