How to reverse bleeding in patients on direct oral anticoagulants?

How to reverse bleeding in patients on direct oral anticoagulants?
Kardiol Pol. 2018 Oct 19;:
Authors: Crowther M, Cuker A
Abstract
The direct oral anticoagulants (DOACs), or non-vitamin K antagonist oral anticoagulants (NOACs), including dabigatran, which inhibits thrombin, and 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 US 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.
PMID: 30338501 [PubMed - as supplied by publisher]

Source: Polish Heart Journal - October 19, 2018 Category: Cardiology Authors: Crowther M, Cuker A Tags: Kardiol Pol Source Type: research