Reversal of the novel oral anticoagulants dabigatran, rivoraxaban, and apixaban

Eric M. Liotta, Kimberly E. Levasseur-Franklin, Andrew M. Naidech*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations

Abstract

Purpose of review We summarize the available data related to reversing the anticoagulant effect of the oral direct thrombin and factor Xa inhibitors and provide our opinion on treating patients presenting with severe and life-threatening hemorrhage related to these agents. Recent findings No specific antidotes are currently available for the oral direct thrombin and factor Xa inhibitors but two promising agents are under investigation in phase 3 trials. No data are available on reversing these agents in bleeding patients. Activated charcoal may be effective in reducing factor Xa inhibitor absorption up to 6h after ingestion. Animal models suggest that unactivated 4-factor prothrombin complex concentrate may be an effective reversal agent. Recent data in warfarin-treated patients suggest that 4-factor prothrombin complex concentrate may provide more rapid and effective hemostasis than fresh frozen plasma. Summary In the absence of evidence in bleeding patients, animal models and ex-vivo studies suggest administration of coagulant factors in the form of hemostatic agents may be of benefit in reversing the effect of direct thrombin and factor Xa inhibitors. Specific reversal agents and clinical data in patients with hemorrhage remain an unmet need.

Original languageEnglish (US)
Pages (from-to)127-133
Number of pages7
JournalCurrent opinion in critical care
Volume21
Issue number2
DOIs
StatePublished - Apr 7 2015

Keywords

  • direct factor Xa inhibitors
  • direct thrombin inhibitor
  • hemorrhage
  • hemostasis
  • intracerebral hemorrhage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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