Management of Bleeding Complications in Patients on New Oral Anticoagulants

Until recently, the Vitamin K antagonist (VKA) warfarin was the only oral anticoagulant available for clinical use. However, with the US FDA approval of new oral anticoagulants (NOAs) such as dabigatran, rivaroxaban and apixaban, there currently exist several choices. With any anticoagulant, bleeding complications are anticipated and require well defined management guidelines. Unlike warfarin, the NOAs present a clinical challenge in the management of bleeding issues due to their lack of specific antidotes/reversal agents. Given the increasing use of NOAs and anticipated challenges associated with bleeding complications, we provide a management overview for physicians based on current evidence based practices.