Anest. intenziv. Med. 2009;20(6):324-331

Bleeding complications and overdosing of anticoagulant therapyGuidelines

Gumulec Jaromír^1,2,*, Kessler Petr³, Procházka Václav^1,4, Brejcha Martin⁵, Grundmann Milan⁶, Penka Miroslav⁷, Zänger Mathias⁸, Machytka Evžen⁹, Klement Petr^1,10

¹ Hematoonkologické a transfuzní centrum FN Ostrava

² Ústav klinické hematologie FN Ostrava

³ Oddělení hematologie a transfuziologie Nemocnice Pelhřimov

⁴ Ústav radiodiagnostický, Pracoviště intervenční neuroradiologie a angiologie FN Ostrava

⁵ Oddělení klinické hematologie Onkologického centra J. G. Mendela Nový Jičín

⁶ Ústav klinické farmakologie FN Ostrava

⁷ Oddělení klinické hematologie FN Brno

⁸ BW, Berlin, Spolková republika Německo

⁹ Interní klinika FN Ostrava

¹⁰ McMaster University and Henderson Research Centre, Hamilton, Kanada

Anticoagulant therapy is one of the most common forms of medical intervention. It is the mainstay of prevention and treatment of thrombotic events. Omission of adequate anticoagulant prophylaxis at least for moderate-risk and high-risk patients is a widely recognized medical error.
Bleeding is one of the most feared complications of anticoagulant therapy, and is a risk of all anticoagulants. Whereas unfractionated heparin and warfarin, the oldest and most widely used anticoagulants, have specific antidotes for their anticoagulant effect, many of the newer agents (direct and indirect inhibitors of coagulation factors Xa and/or IIa) do not have specific antidotes to reverse their actions. The use of novel anticoagulants is further complicated by a lack of easily available laboratory tests to measure their levels and thereby optimize their benefit and safety in clinical practice.
In this review, we evaluate the risk of bleeding associated with current anticoagulants, review the data available on current and experimental agents used for the reversal of anticoagulation, and provide recommendations for the management of major bleeding associated with anticoagulant therapy and for the management of asymptomatic overdosing of the anticoagulants.

Keywords: anticoagulation; bleeding; warfarin; heparin; low molecular weight heparin; fondaparinux; refludan; dabigatran; rivaroxaban

Published: December 1, 2009  Show citation