Another limitation to emergency departments are the
lack of blood tests that can quickly measure how much of
the new anticoagulant is in someone’s system. Unless a
patient or caregiver can tell doctors which anticoagulant
the person takes and when they last took it, hospitals can’t
be sure how well the body could stop bleeding.
This makes it crucial for patients taking a NOAC to keep
a list of medications with them all the time.
“I usually recommend to my patients that they have a
medical alert bracelet or necklace that indicate that they are
on one of these drugs,” Raval said.
Most of the time, the medical team has more time to plan
how they’ll manage bleeding, because medical procedures
are planned, Raval said.
Before an operation to remove a gall bladder, or a
colonoscopy, for example, patients simply stop taking
NOACs for a day or two to clear it from the body,
This is a distinct advantage over warfarin, which takes
approximately five days to clear, according to the statement.
Warfarin patients may also require injections of heparin, a
fast-acting anticoagulant only available via injection or IV, to
reduce the risk of clots while waiting for their procedure.
After patients are stabilized, doctors have to consider
each patient’s risk of clotting and bleeding before putting
them back on their NOAC, Raval said. The fast ramp-up of
the drugs provides an advantage over warfarin, which can
take up to 10 days to become fully effective.
According to experts, patient fears about the bleeding
risks of the new drugs may be overblown.
“In broad strokes, I think the press on NOACs has
been a bit unfair,” Raval said. “Patients who take these
drugs should take some comfort in knowing that these
drugs are safe.”
“I often have patients come into my office and say, ‘I
don’t want to take that drug because I hear all the bad things
about it on the lawyer commercials, but I never hear bad
things about warfarin so it must be safer,’” Barnes said. “And
I’m often telling patients, ‘Just because you don’t hear about
a drug on TV doesn’t mean that it’s safer or less safe than
what’s out there right now.’”
“All of these drugs have been tested in tens of thousands
of people,” he said. “The bleeding we can usually manage. A
stroke or blood clot often can be deadly,” Barnes said.