Management of Bleeding with Non Vitamin K Oral Anticoagulants

Bleeding is a potential side effect with the use of anticoagulation. The non-vitamin K oral anticoagulants (NOACS) are as effective as warfarin for stroke prevention in non-valvular atrial fibrillation and also for the prevention and treatment of venous thromboembolic disease. They have demonstrated favourable safety profiles when compared to warfarin with significantly lower risk of haemorrhagic stroke. Furthermore regular therapeutic monitoring is not necessary which may be more acceptable to patients, leading to its widespread use. However if major bleeding occurs there is no universal index of measure for the coagulation effect of the NOACS or antidotes available. In patients who require invasive procedures guidance has been given with regards to drug discontinuation. The management of bleeding sequelae from NOACS may be less familiar to non-specialists and this article sets out to review the current literature regarding bleeding management of the four NOACS.