Prothrombin Complex Concentrate for Bleeding from Direct Oral Anticoagulants

Direct oral anticoagulants (DOACs) are infrequently associated with major bleeding. Hemorrhages in patients receiving dabigatran are managed with idarucizumab (NEJM JW Oncol Hematol Oct 2017 and N Engl J Med 2017; 377:431), but for those on other DOACs, a new agent, andexanet (NEJM JW Oncol Hematol Oct 2016 and N Engl J Med 2016; 375:1131), is still under evaluation and not yet approved.

To determine whether a four-factor prothrombin complex concentrate (PCC) can safely control major bleeding in patients receiving apixaban or rivaroxaban, investigators conducted an observational study of patients who had taken one of these DOACs within 24 hours. Of 84 patients, 70% had intracranial hemorrhages and 15.5% had gastrointestinal bleeding. The PCC…