Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. This should be taken into account when choosing the DOAC for the prevention of thromboembolic events in patients with AF. Currently, in our country only dabigatran has a reversing agent available, making it the only DOAC that does not contraindicate the use of intravenous thrombolysis.
The possibility of having a reversal agent should be taken into account when choosing a DOAC, especially due to the residual risk of stroke occurrences even under DOACs. Between 1-2% of patients correctly treated with a DOAC experience a stroke each year. The choice of a DOAC arose from patient carachterictis, physician preferences, cost, and accessibility. There are no studies comparing the efficacy of DOACs with each other. Direct oral anticoagulants (DOACs), such as the direct thrombin inhibitor dabigatran, or the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, have a more favorable effectiveness/safety profile compared to VKAs. Until recently, anticoagulation with vitamin K antagonists (VKAs) was the only available option.
The main objective of anticoagulation in patients with AF is prevention of stroke. Non-valvular atrial fibrillation (AF) is the most prevalent arrhythmia with high embolic potential, and one of the main and growing causes of stroke.
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