Abstract：
To investigate and describe the protocolized treatment of DOAC-related bleeds in all Dutch hospitals.
From August to December 2020 a nationwide survey among all 70 hospitals in the Netherlands was conducted on their protocols for management of bleeding in patients treated with direct oral anticoagulants (DOACs, i.e. apixaban, edoxaban, rivaroxaban and dabigatran). The protocols were assessed the following characteristics: bleeding definitions (mild, moderate and severe bleed), diagnostic parameters (hemoglobin [Hb], loss of blood, surgical procedure needed, etc), first and second choice of treatment, effectiveness criteria and the level of evidence/references upon which protocols were based.
All 70 hospitals responded (100%). We received 69 protocols in total, 6 of which were identical because hospitals worked together. In 35 (50%) of the protocols a definition of minor, moderate or severe bleeds was described. Diagnostic parameters for bleeds were present in 2%, 41% and 47% of protocols for a mild, moderate and severe bleed. While the first choice treatment for severe bleeding under dabigatran was idarucizumab in 96% of protocols, considerably more therapeutic options (mostly different prothrombin complex concentrate (PCC) doses) are described for Xa inhibitors. When considering criteria for effectiveness more than 90% of protocols did not have a clear description.
This study provides an overview of the current state of protocols for management of DOAC-related bleeding in The Netherlands. Protocols vary in the content of information provided and often do not include information, especially for diagnostic criteria and criteria for establishing the effectiveness of the intervention. The results of this study can assist in improving and harmonizing the protocols.
From August to December 2020 a nationwide survey among all 70 hospitals in the Netherlands was conducted on their protocols for management of bleeding in patients treated with direct oral anticoagulants (DOACs, i.e. apixaban, edoxaban, rivaroxaban and dabigatran). The protocols were assessed the following characteristics: bleeding definitions (mild, moderate and severe bleed), diagnostic parameters (hemoglobin [Hb], loss of blood, surgical procedure needed, etc), first and second choice of treatment, effectiveness criteria and the level of evidence/references upon which protocols were based.
All 70 hospitals responded (100%). We received 69 protocols in total, 6 of which were identical because hospitals worked together. In 35 (50%) of the protocols a definition of minor, moderate or severe bleeds was described. Diagnostic parameters for bleeds were present in 2%, 41% and 47% of protocols for a mild, moderate and severe bleed. While the first choice treatment for severe bleeding under dabigatran was idarucizumab in 96% of protocols, considerably more therapeutic options (mostly different prothrombin complex concentrate (PCC) doses) are described for Xa inhibitors. When considering criteria for effectiveness more than 90% of protocols did not have a clear description.
This study provides an overview of the current state of protocols for management of DOAC-related bleeding in The Netherlands. Protocols vary in the content of information provided and often do not include information, especially for diagnostic criteria and criteria for establishing the effectiveness of the intervention. The results of this study can assist in improving and harmonizing the protocols.
摘要：
UNASSIGNED：调查和描述所有荷兰医院DOAC相关出血的原型治疗。
UNASSIGNED：从2020年8月至12月，在荷兰所有70家医院中进行了一项全国性调查，以了解直接口服抗凝药治疗患者的出血管理方案（DOACs，即阿哌沙班，edoxaban,利伐沙班和达比加群)。方案评估了以下特征：出血定义（轻度，中度和重度出血)，诊断参数(血红蛋白[Hb]，失血,需要外科手术,etc),第一和第二选择治疗，有效性标准和协议所依据的证据/参考水平。
未经评估：所有70家医院均有反应（100%）。我们总共收到了69份协议，其中6个是相同的，因为医院一起工作。在35（50％）的协议中，未成年人的定义，描述了中度或重度出血。出血的诊断参数为2%，41%和47%的协议用于轻度，中度和重度出血。虽然在96％的方案中，达比加群治疗严重出血的首选治疗是idarucizumab，针对Xa抑制剂描述了更多的治疗选择(主要是不同的凝血酶原复合物浓缩物(PCC)剂量).当考虑有效性标准时，超过90％的方案没有明确的描述。
UNASSIGNED：本研究概述了荷兰DOAC相关出血治疗方案的现状。协议提供的信息内容各不相同，通常不包括信息，特别是诊断标准和建立干预措施有效性的标准。这项研究的结果可以帮助改进和协调协议。
UNASSIGNED：从2020年8月至12月，在荷兰所有70家医院中进行了一项全国性调查，以了解直接口服抗凝药治疗患者的出血管理方案（DOACs，即阿哌沙班，edoxaban,利伐沙班和达比加群)。方案评估了以下特征：出血定义（轻度，中度和重度出血)，诊断参数(血红蛋白[Hb]，失血,需要外科手术,etc),第一和第二选择治疗，有效性标准和协议所依据的证据/参考水平。
未经评估：所有70家医院均有反应（100%）。我们总共收到了69份协议，其中6个是相同的，因为医院一起工作。在35（50％）的协议中，未成年人的定义，描述了中度或重度出血。出血的诊断参数为2%，41%和47%的协议用于轻度，中度和重度出血。虽然在96％的方案中，达比加群治疗严重出血的首选治疗是idarucizumab，针对Xa抑制剂描述了更多的治疗选择(主要是不同的凝血酶原复合物浓缩物(PCC)剂量).当考虑有效性标准时，超过90％的方案没有明确的描述。
UNASSIGNED：本研究概述了荷兰DOAC相关出血治疗方案的现状。协议提供的信息内容各不相同，通常不包括信息，特别是诊断标准和建立干预措施有效性的标准。这项研究的结果可以帮助改进和协调协议。
