Direct oral anticoagulants or vitamin K antagonists in emergencies: comparison of management in an observational study

Background: Restoring hemostasis in patients on oral anticoagulants presenting with major hemorrhage (MH) or before surgical intervention has changed, with the replacement of vitamin K antagonist (VKA) with direct oral anticoagulants (DOACs). Objectives: To observe the difference in urgent hemostatic management between patients on VKA and those on DOACs. Methods: A multicenter observational study evaluated the variation in laboratory testing, hemostatic management, mortality, and hospital length of stay (LOS) in patients on VKA or DOACs presenting with MH or urgent hemostatic restoration. Results: Of the 1194 patients analyzed, 783 had MH (61% VKA) and 411 required urgent hemostatic restoration before surgery (56% VKA). Compared to the international normalized ratio (97.6%), plasma DOAC levels were measured less frequently (<45%), and the time taken from admission for the coagulation sample to reach the laboratory varied widely (median, 52.3 minutes; IQR, 24.8-206.7). No significant plasma DOAC level (<50 ng/mL) was found in up to 19% of patients. There was a poor compared with patients receiving VKA (96.5%) or dabigatran (93.7%), fewer patients overall 30-day mortality for MH (mean: 17.8%) and length of stay (LOS) (median: 8.7 Conclusion: In DOAC patients, when compared to those receiving VKA, plasma addition, following MH, mortality and LOS were similar between VKA and DOAC

Automated summary

This study observed the difference in urgent hemostatic management between patients on VKA and those on DOACs. The results showed that in DOAC patients, the frequency of measuring DOAC plasma levels was low, the time for the coagulation sample to reach the laboratory varied widely, and some patients had insufficient plasma DOAC concentrations.