Neither type of direct-acting oral anticoagulant (DOAC) nor administration of prothrombin complex concentrate (PCC) was associated with mortality rate or length of hospital stay, according to a study published in the British Journal of Haematology.

Researchers obtained data of patients admitted for major bleeding while using a DOAC from 32 hospitals in the United Kingdom. In total, 421 patients were included in the analysis; 283 patients took rivaroxaban, 89 patients took apixaban, 46 patients took dabigatran, and 3 patients took edoxaban.

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The researchers assessed bleeding location, PCC dose, and laboratory test results at time of admission. They also studied laboratory test results from immediately after administration of any intervention or within 2 days of admission if no intervention was given; however, 10% of patients died within 2 days of admission, leading to considerable missing data for this time point.

Intracranial hemorrhage was present in 155 patients and was the most common type of bleed in patients taking apixaban. Gastrointestinal bleeding occurred in 186 patients and was the most common type of bleed in patients taking dabigatran or rivaroxaban.

No difference was found between patient groups for hemoglobin concentration, platelet count, and fibrinogen levels. However, patients taking dabigatran and rivaroxaban demonstrated prolonged prothrombin time. Patients taking dabigatran also demonstrated prolonged activated partial thromboplastic time.

Overall, 301 patients received some form of blood component, tranexamic acid, or PCC. PCC was given to 5% of patients with intracranial hemorrhage and 32% of patients with gastrointestinal bleeding. Thromboembolic events occurred in 8 patients but were not linked to PCC administration (P =.49).

The mortality rate within 30 days of admission was 22.3%, with no difference between patient groups (P =.66). PCC dose was not found to be associated with risk of death, but intracranial hemorrhage (P <.001) and history of stroke (P =.006) were associated with higher incidence of death.

The authors noted that “evidence of effectiveness for [the use of PCC] remains uncertain” but acknowledged that due to the lack of alternative agents for reversal of DOAC activity, PCC would likely remain “part of the management strategy.” They concluded that their results “have provided the impetus and underscored the need…to evaluate the clinical efficacy of PCC in the treatment of DOAC-related bleeding.”

Disclosures: Some study authors have declared affiliations with the pharmaceutical industry. For a full list of disclosures, please refer to the original study.

Reference

1.     Green L, Tan J, Antoniou S, et al. Haematological management of major bleeding associated with direct oral anticoagulants — UK experience [published online February 19, 2019]. Br J Haematol. doi:10.1111/bjh.15808