Drug-induced Bleeding

Johnathan W. Hamrick, PharmD; Diane Nykamp, PharmD


US Pharmacist. 2015;40(12):17-21. 

In This Article

Anticoagulants and Antiplatelets

Anticoagulants are used for the prevention and treatment of deep venous thrombosis, pulmonary embolism, and thromboembolism and for the prevention of stroke in atrial fibrillation.[6] Common anticoagulants and antiplatelets include aspirin, enoxaparin, clopidogrel, heparin, warfarin, and the novel oral anticoagulants (NOAs) apixaban, dabigatran, rivaroxaban, and edoxaban.

Warfarin inhibits vitamin K–dependent factors II, VII, IX, and X in the liver, and its effects can be reversed with the administration of vitamin K. NOAs are direct inhibitors of factor Xa (rivaroxaban, apixaban, edoxaban) and thrombin (factor IIa, dabigatran). Bleeding associated with their use is treated with the administration of RBCs and plasma, activated prothrombin complex concentrate, or recombinant factor VIIa, hemodialysis, or idarucizumab for dabigatran.[6,7] The treatment of bleeding associated with NOAs is both controversial and expensive.