HEMORRHAGIC COMPLICATIONS ASSOCIATED WITH THE USE OF DIRECT ORAL ANTICOAGULANTS

Nikica Sabljić; Nikola Pantić; Lazar Trajković; Predrag Miljić; Marijana Virijević; Jelena  Bodrožić; Zlatko  Pravdić; Mirjana Cvetković; Nada Suvajdžić-Vuković; Mirjana Mitrović

doi:10.5937/smclk5-52277

Nikica Sabljić University Clinical Center of Serbia, Clinic of Hematology https://orcid.org/0000-0001-5488-126X
Nikola Pantić Clinic of Hematology, University Clinical Center of Serbia https://orcid.org/0000-0001-7798-4026
Lazar Trajković University Clinical Center of Serbia, Clinic of Hematology
Predrag Miljić University Clinical Center of Serbia Clinic of Hematology https://orcid.org/0000-0003-0807-1308
Marijana Virijević University Clinical Center of Serbia, Clinic of Hematology; University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0000-0003-4626-4215
Jelena Bodrožić University Clinical Center of Serbia, Clinic for Hematology; University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0000-0002-0637-6856
Zlatko Pravdić https://orcid.org/0000-0001-5095-7327
Mirjana Cvetković University Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia https://orcid.org/0000-0002-0907-7552
Nada Suvajdžić-Vuković University Clinical Center of Serbia, Clinic for Hematology; University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0000-0002-8807-4797
Mirjana Mitrović University Clinical Center of Serbia, Clinic for Hematology; University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0000-0001-8313-3754

DOI: https://doi.org/10.5937/smclk5-52277

Keywords: bleeding risk, venous thromboembolism, anticoagulants

Abstract

The milestone of treating and preventing venous thromboembolism (VTE) is the application of anticoagulants. For many years the cornerstone was the use of vitamin K antagonists (VKAs), but it was associated with numerous obstacles and complications. With the introduction of a new generation of direct oral anticoagulants (DOAC), some of the difficulties, such as delayed onset/offset of the action, individual dose modifications, inhibition of several coagulation factors, need for frequent monitoring of prothrombin time, multiple drug interactions, have been overcome, while maintaining an adequate safety profile. Therefore, DOACs have rapidly replaced VKAs as a standard of care in the treatment and prevention of VTE, as well as in the prevention of ischemic complications in patients with non-valvular atrial fibrillation. However, the expected consequence of the use of anticoagulant drugs is increased bleeding risk. Several randomized and retrospective studies have analyzed the risk of bleeding associated with the use of DOACs compared to VKAs and between DOACs. It has been clearly shown that intracranial hemorrhage risk is decreased with DOAC compared to VKA, while most studies have shown that the risk of major bleeding is the same or even lower with DOAC. Considering DOAC's efficacy, excellent safety, and simple application compared with VKAs, it does not surprise their increasingly frequent application in everyday clinical practice. Will VKAs gradually become a part of history, or will their use be limited to a specific, clearly defined population? The time has to show.

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