This time, we review the current options for emergent reversal of DOACs (direct oral anticoagulants) for a major, life threatening bleed. Plus, we discuss some recent literature published regarding use of PCCs (pro-thrombin complex concentrate) and andexanet alfa. In summary, emergent reversal of DOACs in major bleeding is clear as mud.

Connolly SJ, Crowther M, Eikelboom JW, et al. Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med. 2019;380:1326-35. Peled H, Dau NQ, Lau H. Key points to consider when evaluating Andexxa for formulary addition. Neurocrit Care. 2019. https://doi.org/10.1007/s12028-019-00866-6. Piran S, Khatib R, Schulman S, et al. Management of direct factor Xa inhibitor-related major bleeding with prothrombin complex concentrate: a meta-analysis. Blood Advances. 2019;3(2):158-167. Kaide CG, Gulseth MP. Current strategies for the management of bleeding associated with direct oral anticoagulants and a review of investigational reversal agents. J Emerg Med. 2019. https://doi.org/10.1016/j.jemermed.2019.10.011. Schulman S, Kearon C and. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patients. Journal of Thrombosis and Haemostasis, 3: 692-694. doi:10.1111/j.1538-7836.2005.01204.x Khorsand N, Majeed A, Sarode R, et al. Assessment of effectiveness of major bleeding management: proposed definitions for effective hemostasis: communication from the SSC of the ISTH. J Thromb Haemost 2016; 14: 211– 4.

This podcast is intended for healthcare professionals and students only. Materials presented are for informational purposes, not to be used as medical advice or treatment.