Direct oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, apixaban, and edoxaban, have many advantages over warfarin for treating patients with thromboembolic issues. DOACs may be reversed by agents such as activated and inactivated prothrombin complex concentrates (PCCs), idarucizumab and andexanet alfa. In order to determine the safety and efficacy of reversing DOACs in bleeding emergencies, researchers recently performed a systematic literature review and meta-analysis on all available data. In total, 4 observational cohort studies (n=230 bleeding patients) and 8 randomized controlled trials (n=381 healthy volunteers) were examined. Although the efficacy of reversing DOACs in patients with emergency bleeding was not clear, current evidence suggests that reversal agents are effective when assessed by laboratory anticoagulation assays. Prothrombin complex concentrates decreased the mean prothrombin time by 1.68 second in healthy volunteers. More importantly, no safety issues for DOAC reversal agents were identified. Further clinical data for all DOAC reversal agents is needed.
Teodoro da Luz L, Marchand M, Nascimento B, Tien H, Nathens A, and P. Shah. Efficacy and safety of the drugs used to reverse direct oral anticoagulants: a systematic review and meta-analysis. Transfusion 2017;57;1834-1846.