[Bleedings under NOAC (non XXXX dependent oral anticoagulants). Evidence and practical management].

@entity1 @entity291 @entity33081 @entity548 @entity2067 @entity3926 @entity177 @entity9900 @entity3925 @entity1031 @entity15796 @entity5424 @entity360
UNASSIGNED: The doses of these drugs are barely tested and the potential clinical @entity1031 risk must be taken into account. Despite the widespread use of NOAC (non @entity2067 dependent oral anticoagulants) and recommendations of regulatory agencies and first consensus meeting on handling the @entity548 situation under NOAC, especially in hospitals without a large hemostatic focus, uncertainty still exists. In case of mild @entity548 from a clinical perspective, the medical care of these @entity1 and the delay of the next dose or discontinuation is advised. A special laboratory analysis is indicated i.e. in case of known higher grade liver and @entity177 , which can cause a prolonged elimination of NOAC. The administration of factor concentrates is not indicated in this situation. In case of moderate to severe @entity548 , the primary measures focus on the stabilization of the heart and circulatory function and parallel on the treatment depending on the localization of the @entity548 source. According to experience, mostly @entity360 occurs under the NOAC, which should be supplied endoscopically. In life-threatening @entity548 in addition to the measures of hemodynamic stabilization usually a special haemostasis management is required, which should be mainly clinically oriented. After the assessment of @entity548 predictor, the time of the last dose and the dose of @entity15796 should be learned, but other causes of @entity548 , including Fibrinolysis, should be excluded or treated. Subsequently, routinely promptly @entity3925 and/or @entity5424 sensitive thromboplastin time (Quick's value) and a @entity9900 time ( @entity9900 -poor calibrator) for qualitative assessment can be carried out because only very few hospitals have specific tests (anti-Xa measurements, @entity291 @entity9900 ), which could be promptly done. If there is a significant deviation from the normal range or to present preliminary value of particular @entity1 , an effect of NOAC most likely exists. In life-threatening @entity548 the use of factor concentrates (procoagulants) is indicated. The first-line therapy should be PPSB. Only in exceptional cases, especially when @entity3926 is taken, the use of aPPSB ( @entity33081  ) for prompt haemostasis can be considered. The haemostasis should be always clinically estimated and not according to coagulation tests. The use of rFVIIa (Novo Seven  ) shows different results in the @entity548 therapy (reversal) under @entity3926 . The doses of these drugs are barely tested and the potential clinical @entity1031 risk must be taken into account. CONCLUSION: The current concepts of the newly developed antidotes are not clinically validated. First prospective, clinical registries have been started.
