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Vol 77, No 1 (2019)
Reviews
Published online: 2018-09-24
Submitted: 2018-09-13
Accepted: 2018-09-13
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How can we reverse bleeding in patients on direct oral anticoagulants?

Mark Crowther, Adam Cuker
DOI: 10.5603/KP.a2018.0197
·
Pubmed: 30338501
·
Kardiol Pol 2019;77(1):3-11.

open access

Vol 77, No 1 (2019)
Reviews
Published online: 2018-09-24
Submitted: 2018-09-13
Accepted: 2018-09-13

Abstract

The direct oral anticoagulants (DOACs), or non-vitamin K antagonist oral anticoagulants (NOACs), including dabigatran, which inhibits thrombin, as well as rivaroxaban, apixaban, edoxaban, and betrixaban, which inhibit coagulation factor Xa, are as­sociated with similar or lower risk of bleeding compared with warfarin. The need for reversal of their anticoagulant effect may occur in patients with life-threatening bleeding or those requiring urgent surgery. Currently, the only specific reversal agent for dabigatran, idarucizumab, is widely available, while andexanet alfa, which reverses factor Xa inhibitors, was approved in the United States in May 2018. Ciraparantag, which has been designed to reverse all DOACs and other anticoagulants, is being investigated in clinical trials. In the absence of licensed reversal agents for the oral factor Xa inhibitors, prothrombin complex concentrates are suggested in patients with life-threatening bleeding. Vitamin K and fresh frozen plasma should not be used to reverse DOACs. This review presents the current evidence regarding bleeding risk on DOACs and the reversal strategies to provide guidance on the management of patients treated with DOACs, who experience serious bleeding.

Abstract

The direct oral anticoagulants (DOACs), or non-vitamin K antagonist oral anticoagulants (NOACs), including dabigatran, which inhibits thrombin, as well as rivaroxaban, apixaban, edoxaban, and betrixaban, which inhibit coagulation factor Xa, are as­sociated with similar or lower risk of bleeding compared with warfarin. The need for reversal of their anticoagulant effect may occur in patients with life-threatening bleeding or those requiring urgent surgery. Currently, the only specific reversal agent for dabigatran, idarucizumab, is widely available, while andexanet alfa, which reverses factor Xa inhibitors, was approved in the United States in May 2018. Ciraparantag, which has been designed to reverse all DOACs and other anticoagulants, is being investigated in clinical trials. In the absence of licensed reversal agents for the oral factor Xa inhibitors, prothrombin complex concentrates are suggested in patients with life-threatening bleeding. Vitamin K and fresh frozen plasma should not be used to reverse DOACs. This review presents the current evidence regarding bleeding risk on DOACs and the reversal strategies to provide guidance on the management of patients treated with DOACs, who experience serious bleeding.

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Keywords

bleeding, non-vitamin K antagonist oral anticoagulants, reversal agents

About this article
Title

How can we reverse bleeding in patients on direct oral anticoagulants?

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 77, No 1 (2019)

Pages

3-11

Published online

2018-09-24

DOI

10.5603/KP.a2018.0197

Pubmed

30338501

Bibliographic record

Kardiol Pol 2019;77(1):3-11.

Keywords

bleeding
non-vitamin K antagonist oral anticoagulants
reversal agents

Authors

Mark Crowther
Adam Cuker

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