Safeguarding patients on anticoagulants against the risk of bleeding is a key role for pharmacists, Peter Verhamme of the Centre for Molecular and Vascular Biology at the University of Leuven in Belgium, told the European Association of Hospital Pharmacists conference, held in Germany earlier this year.

The prevention of stroke outweighs the risk of bleeding with anticoagulant treatment but the risk of bleeding and the lack of an antidote to the new oral anticoagulants (NOACs) is often seen as a barrier to use. Studies that compared NOACs with vitamin K antagonists (VKAs) for stroke prevention in patients with atrial fibrillation show that the overall risk of bleeding is reduced with NOACs.

There is less risk of intracranial bleeding and major bleeding but the risk of gastrointestinal bleeding is increased, he said. The most likely explanation is that these patients are particularly frail, but these are the patients who benefit most from NOACs (because of the reduced risk of bleeding). The management of NOACassociated bleeding differs from VKA-assisted bleeding because there is no antidote at present.

In fact, for minor bleeds no action is required. The main message is not to stop taking the anticoagulant. “In these patients we prioritise stroke prevention over nuisance bleeds,” Professor Verhamme said, adding that it is also important to review concomitant medication in case changes can be made.