Managing bleeding in anticoagulated patients with a focus on novel therapeutic agents

Authors

  • M. A. CROWTHER,

    1. Chair of the Division of Hematology, Department of Medicine
    2. Department of Pathology and Molecular Medicine, and Department of Medicine
    3. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
    Search for more papers by this author
  • T. E. WARKENTIN

    1. Department of Pathology and Molecular Medicine, and Department of Medicine
    2. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
    Search for more papers by this author

Mark A. Crowther, Room L208 St Joseph’s Hospital, 50 Charlton Ave. East, Hamilton, ON, L8N 4A6 Canada.
Tel.: +1 905 522 1155; fax: +1 905 540 6568.
E-mail: crowthrm@mcmaster.ca

Abstract

Summary.  Heparin, low molecular weight heparin (LMWH) and coumarins are familiar to most clinicians, inexpensive, highly effective when correctly used and widely available. However, coumarin has a delayed onset of action, interacts with many medications, has a narrow therapeutic window, and can cause thrombosis in some settings (e.g. hereditary protein C deficiency, heparin induced thrombocytopenia, warfarin loading). Additionally, warfarin and heparin require monitoring of their therapeutic effect. These real and perceived limitations have led to the development of ‘novel’ anticoagulants. However, these new agents have one general limitation – a lack of a widely available antidote. We focus on the management of bleeding in anticoagulated patients, with particular regard to novel anticoagulants.

Ancillary