Management of major bleeding in patients treated with direct oral anticoagulants: From experience to standardized protocols

Sara Mascia, Anna Maria Ferrari, Nicola Macarone Palmieri, Elisa Romagnoli, Chiara Catena, Serena Scarabottini, Francesca Mori, Lucio Brugioni

Research output: Contribution to journalArticlepeer-review


Evaluation of clinical-laboratory-therapeutic management and related clinical outcomes (thrombotic-hemorrhagic complications) of patients undergoing treatment with direct oral anticoagulants (DOACs) during major bleeding. This is a two-year observational retrospective study. 27 cases of major bleeding in patients undergoing a therapy with DOACs presented to the Emergency Department of Arcispedale Santa Maria Nuova (Reggio Emilia Hospital). 16 cases (59%) underwent reversal of anticoagulation treatment: 19% using specific reversal therapy (idarucizumab) and 81% using non-specific agents [4-factor prothrombin complex concentrate (4F-PCC)]. Routine laboratory data were available for all the cases, but only for some patients it was possible to obtain the plasma dosage of the oral anticoagulant. Laboratory data confirm rapid correction of activated partial thromboplastin time within one hour from the reversal of anticoagulation with idarucizumab. The absence of correlation between standard blood tests and plasma drug dosage in patients treated with factor Xa Inhibitors was confirmed too. The management of major bleeding during treatment with DOACs using reversal therapy (idarucizumab) and non-specific reversal agent (4F-PCC) showed minimal thrombotic (0.3%) and hemorrhagic (0.3%) complications at 90 days; no events occurred after 6 months.

Original languageEnglish
Pages (from-to)43-48
Number of pages6
JournalItalian Journal of Medicine
Issue number2
Publication statusPublished - Jun 17 2020


  • 4-factor prothrombin complex concentrate
  • Factor Xa inhibitors
  • Idarucizumab
  • Major bleeding
  • New oral anticoagulants

ASJC Scopus subject areas

  • Medicine(all)


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