The objective of this document is to guide healthcare professionals on the management of patients receiving antithrombotic drugs who experience significant bleeding or who require emergency surgery or an invasive procedure.
The guideline writing group was selected to be representative of UK-based medical experts. The MEDLINE and EMBASE databases were searched systematically for publications in English from 1966 to June 2011 and 1980 to June 2011 respectively, using the following strategy: Approved and proprietary names of the antithrombotic agents described in the guideline were combined with terms relating to antidote, reversal, haemorrhage, (activated) prothrombin complex concentrate, factor VIII inhibitor bypass activity (FEIBA), Beriplex, Octaplex, recombinant activated factor VII (rFVIIa), Novoseven, fresh frozen plasma, tranexamic acid, antifibrinolytic, platelet transfusion, and desmopressin. Identified papers were also searched for additional references. The writing group produced the draft guideline which was subsequently revised by consensus by members of the Haemostasis and Thrombosis task Force of the British Committee for Standards in Haematology (BCSH). The guideline was then reviewed by a sounding board of approximately 50 UK haematologists, the BCSH and the British Society for Haematology Committee and comments incorporated where appropriate. Criteria used to quote levels and grades of evidence are as outlined in: http://www.bcshguidelines.com/BCSH_PROCESS/EVIDENCE_LEVELS_AND_GRADES_OF_RECOMMENDATION/43_GRADE.html.
The objective of this document is to guide healthcare professionals on the management of patients receiving antithrombotic drugs who experience significant bleeding or who require emergency surgery or an invasive procedure. Guidance on reversal of vitamin K antagonists (VKAs; warfarin, phenprocoumon, acenocoumarol (sinthrome) and phenindione has been described previously (Keeling et al, 2011).
Antithrombotic drugs are used increasingly in patient groups at greater bleeding risk. Although major haemorrhage is infrequent, management can be difficult especially with antithrombotics for which there are no specific reversal agents. Bleeding during antithrombotic therapy is associated with high morbidity and mortality (Linkins et al, 2003; Eikelboom et al, 2006; Mannucci & Levi, 2007). Before any antithrombotic treatment is started, the risks and benefits should be carefully considered. In this guideline we consider the management of bleeding in patients on the more widely used antithrombotic agents including heparin, anti-IIa and anti-Xa inhibitors, oral VKAs, anti-platelet drugs as well as the fibrinolytic agents.
Declaration of Interests
The BSH paid the expenses incurred during the writing of this guidance. None of the authors had conflicts of interest to declare. All authors have made a declaration of interests to the BSH and Task Force Chairs which may be viewed on request.