CLINICAL CARE PATHWAY AND MANAGEMENT OF MAJOR BLEEDING ASSOCIATED WITH NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS: A MODIFIED DELPHI CONSENSUS FROM SAUDI ARABIA AND UAE
Background: The non-vitamin K antagonist oral anticoagulants (NOACs) have become the mainstay anticoagulation therapy for patients requiring oral anticoagulants (OACs) in the Gulf Council Cooperation (GCC) countries. The frequency of NOAC-associated major bleeding is expected to increase in the Eme...
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| Format: | Article |
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PAGEPress Publications
2024-04-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
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| Online Access: | https://www.mjhid.org/mjhid/article/view/5591 |
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| author | Abdulrahman Al Raizah Fakhr Alayoubi Galal Hassan Abdelnaby Hazzaa Alzahrani Majid Farraj Bakheet Mohammed A Alskaini Rasha Buhumaid Sameer Al Awadhi Sara Nooruddin Kazim Thiagarajan Jaiganesh Zohair Al Asiri |
| author_facet | Abdulrahman Al Raizah Fakhr Alayoubi Galal Hassan Abdelnaby Hazzaa Alzahrani Majid Farraj Bakheet Mohammed A Alskaini Rasha Buhumaid Sameer Al Awadhi Sara Nooruddin Kazim Thiagarajan Jaiganesh Zohair Al Asiri |
| author_sort | Abdulrahman Al Raizah |
| collection | DOAJ |
| description |
Background: The non-vitamin K antagonist oral anticoagulants (NOACs) have become the mainstay anticoagulation therapy for patients requiring oral anticoagulants (OACs) in the Gulf Council Cooperation (GCC) countries. The frequency of NOAC-associated major bleeding is expected to increase in the Emergency Department (ED). Nonetheless, we still lack local guidelines and recommendations for bleeding management in the region. The present Delphi-based consensus aims to establish a standardized and evidence-based clinical care pathway for managing NOAC-associated major bleeding in the Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE).
Methods: We adopted a three-step modified Delphi method to develop evidence-based recommendations through two voting rounds and an advisory meeting between the two rounds. A panel of 11 experts from the KSA and UAE participated in the consensus development.
Results: Twenty-eight statements reached the consensus level. These statements addressed key aspects of managing major bleeding events associated with NOACs, including the increased use of NOAC in clinical practice, clinical care pathways, and treatment options.
Conclusion: The present Delphi consensus provides evidence-based recommendations and protocols for the management of NOAC-associated bleeding in the region. Patients with major NOAC-induced bleeding should be referred to a well-equipped ED with standardized management protocols. A multidisciplinary approach is recommended for establishing the association between NOAC use and major bleeding. Treating physicians should have prompt access to specific reversal agents to optimize patient outcomes. Real-world evidence and national guidelines are needed to aid all stakeholders involved in NOAC-induced bleeding management.
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| format | Article |
| id | doaj-art-d198c39d166c4dd699ec2815659eaeeb |
| institution | Kabale University |
| issn | 2035-3006 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Mediterranean Journal of Hematology and Infectious Diseases |
| spelling | doaj-art-d198c39d166c4dd699ec2815659eaeeb2025-01-03T01:27:30ZengPAGEPress PublicationsMediterranean Journal of Hematology and Infectious Diseases2035-30062024-04-0116110.4084/MJHID.2024.038CLINICAL CARE PATHWAY AND MANAGEMENT OF MAJOR BLEEDING ASSOCIATED WITH NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS: A MODIFIED DELPHI CONSENSUS FROM SAUDI ARABIA AND UAEAbdulrahman Al Raizah0Fakhr Alayoubi1Galal Hassan Abdelnaby2Hazzaa Alzahrani3Majid Farraj Bakheet4Mohammed A Alskaini5Rasha Buhumaid6Sameer Al Awadhi7Sara Nooruddin Kazim8Thiagarajan Jaiganesh9Zohair Al Asiri10https://orcid.org/0000-0001-9869-7544Division of Adult Hematology, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, PO Box. 22490, 11426, Riyadh, Saudi ArabiaKing Saud University, Riyadh, Saudi ArabiaAlqassimi Hospital, United Arab EmiratesKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaNeurology Department, King Abdullah Medical City, Mecca, Saudi ArabiaDepartment of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi ArabiaMohammed Bin Rashid University of Medicine and Health Science, Dubai, UAE.Digestive Diseases Unit, Rashid Hospital, Dubai, United Arab EmiratesDepartment of Emergency Medicine, Rashid Hospital and Trauma Centre, Dubai Health Authority, Dubai, UAEEmergency Department, Tawam Hospital, Al Ain, UAE1Department Emergency Medicine and Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia. 2Department of Clinical Sciences, College of Medicine and Riyadh University Hospital, Dar Al Uloom University, Riyadh, Saudi Arabia. 3Emergency and Critical Care Development Program, Therapeutic Deputyship, Ministry of Health, Riyadh, Saudi Arabia. Background: The non-vitamin K antagonist oral anticoagulants (NOACs) have become the mainstay anticoagulation therapy for patients requiring oral anticoagulants (OACs) in the Gulf Council Cooperation (GCC) countries. The frequency of NOAC-associated major bleeding is expected to increase in the Emergency Department (ED). Nonetheless, we still lack local guidelines and recommendations for bleeding management in the region. The present Delphi-based consensus aims to establish a standardized and evidence-based clinical care pathway for managing NOAC-associated major bleeding in the Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE). Methods: We adopted a three-step modified Delphi method to develop evidence-based recommendations through two voting rounds and an advisory meeting between the two rounds. A panel of 11 experts from the KSA and UAE participated in the consensus development. Results: Twenty-eight statements reached the consensus level. These statements addressed key aspects of managing major bleeding events associated with NOACs, including the increased use of NOAC in clinical practice, clinical care pathways, and treatment options. Conclusion: The present Delphi consensus provides evidence-based recommendations and protocols for the management of NOAC-associated bleeding in the region. Patients with major NOAC-induced bleeding should be referred to a well-equipped ED with standardized management protocols. A multidisciplinary approach is recommended for establishing the association between NOAC use and major bleeding. Treating physicians should have prompt access to specific reversal agents to optimize patient outcomes. Real-world evidence and national guidelines are needed to aid all stakeholders involved in NOAC-induced bleeding management. https://www.mjhid.org/mjhid/article/view/5591Cost effectiveNon-vitamin K antagonist oral anticoagulantsConsensus |
| spellingShingle | Abdulrahman Al Raizah Fakhr Alayoubi Galal Hassan Abdelnaby Hazzaa Alzahrani Majid Farraj Bakheet Mohammed A Alskaini Rasha Buhumaid Sameer Al Awadhi Sara Nooruddin Kazim Thiagarajan Jaiganesh Zohair Al Asiri CLINICAL CARE PATHWAY AND MANAGEMENT OF MAJOR BLEEDING ASSOCIATED WITH NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS: A MODIFIED DELPHI CONSENSUS FROM SAUDI ARABIA AND UAE Mediterranean Journal of Hematology and Infectious Diseases Cost effective Non-vitamin K antagonist oral anticoagulants Consensus |
| title | CLINICAL CARE PATHWAY AND MANAGEMENT OF MAJOR BLEEDING ASSOCIATED WITH NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS: A MODIFIED DELPHI CONSENSUS FROM SAUDI ARABIA AND UAE |
| title_full | CLINICAL CARE PATHWAY AND MANAGEMENT OF MAJOR BLEEDING ASSOCIATED WITH NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS: A MODIFIED DELPHI CONSENSUS FROM SAUDI ARABIA AND UAE |
| title_fullStr | CLINICAL CARE PATHWAY AND MANAGEMENT OF MAJOR BLEEDING ASSOCIATED WITH NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS: A MODIFIED DELPHI CONSENSUS FROM SAUDI ARABIA AND UAE |
| title_full_unstemmed | CLINICAL CARE PATHWAY AND MANAGEMENT OF MAJOR BLEEDING ASSOCIATED WITH NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS: A MODIFIED DELPHI CONSENSUS FROM SAUDI ARABIA AND UAE |
| title_short | CLINICAL CARE PATHWAY AND MANAGEMENT OF MAJOR BLEEDING ASSOCIATED WITH NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS: A MODIFIED DELPHI CONSENSUS FROM SAUDI ARABIA AND UAE |
| title_sort | clinical care pathway and management of major bleeding associated with non vitamin k antagonist oral anticoagulants a modified delphi consensus from saudi arabia and uae |
| topic | Cost effective Non-vitamin K antagonist oral anticoagulants Consensus |
| url | https://www.mjhid.org/mjhid/article/view/5591 |
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