Assessment and Management of Gastrointestinal Hemorrhage in the Setting of Direct Oral Anticoagulants: The Hematology Perspective

摘要

The direct oral anticoagulants (DOACs) are at least as effective as warfarin, but are easier to administer because they can be given in fixed doses without routine coagulation monitoring. Although DOACs cause less intracranial bleeding than warfarin some are associated with more gastrointestinal (Gl) bleeding than warfarin. Focusing on DOAC-associated Gl bleeding, this paper describes the approach to the management of such patients from the hematology perspective. Key points include (a) measures to reduce the risk of Gl bleeding in patients taking DOACs, (b) determination of the contribution of the DOACs to Gl bleeding, (c) identifying and treating the source of Gl bleeding, (d) indications for anticoagulation reversal, and (e) restarting anticoagulation therapy once the bleeding has stopped.