Title
Reversal of Direct Oral Anticoagulants
Authoring Organization
Publication Month/Year
July 17, 2024
Last Updated Month/Year
October 29, 2024
Supplemental Implementation Tools
Document Type
Consensus
Country of Publication
Global
Document Objectives
The currently approved direct oral anticoagulants (DOACs) are increasingly used in clinical practice. Although serious bleeding risks are lower with DOACs than with vitamin K antagonists, bleeding remains the most frequent side effect. Andexanet alfa and idarucizumab are the currently approved specific reversal agents for oral factor (F)Xa inhibitors and dabigatran, respectively. Our prior guidance document was published in 2016, but with more information available on the utility and increased use of these reversal agents and other bleeding management strategies, we have updated this International Society on Thrombosis and Haemostasis guidance document on DOAC reversal. In this narrative review, we compare the mechanism of action of specific and nonspecific reversal agents, review the clinical data supporting their use, and provide guidance on when reversal is indicated. In addition, we briefly discuss the reversal of oral FXIa inhibitors, a new class of DOACs currently under clinical development.
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Emergency care, Hospital, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Treatment
Diseases/Conditions (MeSH)
D000925 - Anticoagulants, D000089964 - Anticoagulant Reversal Agents
Keywords
reversal, Reversal of Antithrombotics, direct oral anticoagulants, DOACs
Source Citation
Levy JH, Shaw JR, Castellucci LA, Connors JM, Douketis J, Lindhoff-Last E, Rocca B, Samama CM, Siegal D, Weitz JI. Reversal of direct oral anticoagulants: guidance from the SSC of the ISTH. J Thromb Haemost. 2024 Oct;22(10):2889-2899. doi: 10.1016/j.jtha.2024.07.009. Epub 2024 Jul 17. PMID: 39029742.