1 Contact haematologist on call document DOAC taken and last time drug ingested calculate creatinine clearance Cockcroft Gault FBC and check INRAPTTthrombin time Dabigatran Rivaroxaban ID: 1036452
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1. Direct oral anticoagulant (DOAC) haemorrhage protocol1Contact haematologist on call, document DOAC taken and last time drug ingested, calculate creatinine clearance (Cockcroft Gault), FBC and check INR/APTT/thrombin timeDabigatranRivaroxabanApixabanEdoxabanIf <24 hours since last dose, presume anticoagulanteffect presentIf CrCl<50ml/min and <48 hours since last dose,presume anticoagulant effect presentAnticoagulant effect presentMild bleed Moderate bleed Major bleed*Maintain BP and urine output*Major bleed: symptomatic bleedingin a critical area or organ, such asintracranial, intraspinal, intraocular,retroperitoneal, intra-articular,pericardial, or intramuscular withcompartment syndromeCompression of bleeding siteDelay next DOAC dose orDiscontinue treatmentOptimise tissue oxygenationa) Control haemorrhageMechanical compressionSurgical/radiological interventionb) Tranexamic acid 1g IVc) Red cell transfusion (aim Hb >70g/L)d) Platelet transfusion (aim platelets >50x109/L, if CNS bleed >50x109/L)e) Identify source of haemorrhage e.g. surgery, endoscopy, interventional radiology BleedingcontinuesDabigatran only¶Idracizumab 5g IVConsiderhaemofiltration Rivaroxaban/Apixaban/Edoxaban¶ Prothrombin complex concentrate(Octaplex) 25-40U/kg (max. 3000U) IVORIF LIFE-THREATENING HAEMORRHAGE INVOLVING THE GI TRACTAND ON RIVAROXABAN ORAPIXABAN¶ Andexanet alpha (Ondexxya) (dose will beadvised by consultant haematologist)¶ available from Blood Transfusion onlyon Consultant Haematologist authorisationAPTT/TT deranged, anticoagulanteffect present.If APTT/TT normal, no anticoagulant effectpresent. Manage patient as per normalhaemorrhage protocol