Management of haemorrhage in patients receiving non-vitamin-k oral anticoagulants treatment: Case report

Abstract

Introduction: Management of haemorrhage depends on the severity of bleeding and associated injuries. In this paper, we present a case of bleeding patient on the anticoagulants for which there was no specific reversal agent. Aim of the study is to present the management of haemorrhage in a patient on anticoagulant therapy in the General Hospital in Loznica, Serbia. Material and methods: Overview of hospital documentation and physician's reports. Case report: In the abscence of a specific reversal agents and laboratory tests, management of haemorrhage included methods of mechanical/surgical haemorrhage control, application of antifibrinolitics and administration of blood products, such as fresh frozen plasma (FFP), combined with forced diuresis and 7-day clinial follow-up period. NOAC treatment was suspended until the complete stopping of bleeding. After the bleeding was stopped, non-vitamin-K oral anticoagulants (NOAC) treatment was resumed with lowered dosis. Conclusion: In the abscence of specific reversal agents, reversion of NOAC effects is possible in minor haemorrhage. Patients with major haemorrhage should be treated with available specific reversal agents and/or prothrombin complex concentrate (PCC). However, this type of therapy is currrently available only in the terciary health care intitutions.

Keywords

• oral anticoagulants
• bleeding
• risk
• antidote
• laboratory monitoring