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Introduction: Management of haemorrhage depends on the severity of bleeding and associated injuries. In this paper, we present a case of bleeding patient on the anticoagulants for which there was no specific reversal agent. Aim of the study is to present the management of haemorrhage in a patient on anticoagulant therapy in the General Hospital in Loznica, Serbia. Material and methods: Overview of hospital documentation and physician's reports. Case report: In the abscence of a specific reversal agents and laboratory tests, management of haemorrhage included methods of mechanical/surgical haemorrhage control, application of antifibrinolitics and administration of blood products, such as fresh frozen plasma (FFP), combined with forced diuresis and 7-day clinial follow-up period. NOAC treatment was suspended until the complete stopping of bleeding. After the bleeding was stopped, non-vitamin-K oral anticoagulants (NOAC) treatment was resumed with lowered dosis. Conclusion: In the abscence of specific reversal agents, reversion of NOAC effects is possible in minor haemorrhage. Patients with major haemorrhage should be treated with available specific reversal agents and/or prothrombin complex concentrate (PCC). However, this type of therapy is currrently available only in the terciary health care intitutions.

The classical oral anticoagulants are increasingly being replaced in clinical practice by new antithrombotic drugs, which act by enabling direct inhibition of coagulation factor IIa (FIIa) or factor Xa (FXa). These drugs have multiple acronyms, including NOACs (new, non-vitamin K antagonist) or DOACs (direct oral anticoagulants), and currently include dabigatran (FIIa inhibitor), and rivaroxaban, apixaban, and edoxaban (FXa inhibitors). These drugs are approved for stroke prevention in patients with non-valvular atrial fibrillation and the prevention and treatment of venous thromboembolism. The "mantra" that DOACs do not require laboratory monitoring is not entirely correct because laboratory testing for drug effects is needed in many situations, because they influence hemostasis tests and in situations in which urgent measurement of DOACs is required. This should be very important to consider in the clinical situation for numbers of indications and increasing numbers of patients on DOACs therapy. The main aim of this article is to provide practical issues to general laboratory testing for DOACs, as well as to help avoid diagnostic errors associated with hemostasis testing. The assays for DOAC quantification must be available in medical centers on a whole day basis, to facilitate optimal drug management in conditions when things go wrong or in urgent cases of immediate reversal of anticoagulation or appropriate administration of a specific antidote.