Emergency Department Management of Direct Oral Anticoagulants Agents

Abstract

Introduction: Nowadays, direct oral anticoagulants are
commonly used and Emergency Department response regarding its adverse effects and its reversion when invasive procedures are needed is crucial. Regular coagulation tests correlate poorly with plasma concentrations of direct oral anticoagulants, so specialized anti-Xa and anti-IIa assays are necessary.

Methods: In this study, we analyzed all the Emergency Department electronic medical records corresponding to patients that had direct oral anticoagulants quantification assays performed during a six-month period.

Results: Of the 88 admissions evaluated, the main indications for anticoagulation were atrial fibrillation or flutter and previous thrombotic events. Direct oral anticoagulants quantification was performed mainly due to hemorrhagic events and need for urgent invasive technical procedures. At admission, most patients had direct oral anticoagulants concentrations > 50 ng/mL and more than half had their anticoagulation suspended at discharge (pending further evaluation in an outpatient setting). 26% did prothrombin complex and 5% did Idarucizumab, due to clinical severity. None of the patients did Andexanet alfa due to its unavailability. Regarding readmissions within 6 months, only 5 patients were readmitted, with recurrent bleeding or anemia and no thromboembolic events were registered.

Conclusion: Direct oral anticoagulants quantification minimized unnecessary complications associated with urgent surgical and invasive technical procedures. Creating Emergency Department protocols, accessible to all specialties, regarding direct oral anticoagulants quantification and its main indications, should be a priority in anticoagulation management, guiding clinical decisions and reducing duration of hospital stay, comorbidities and mortality.