title: Reversal of target-specific oral anticoagulants.
abstract: Target-specific oral anticoagulants (TSOACs) provide safe and effective anticoagulation for the prevention and treatment of thrombosis in a variety of clinical settings by interfering with the activity of thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban, edoxaban, betrixaban). Although TSOACs have practical advantages over vitamin K antagonists (VKAs), there are currently no antidotes to reverse their anticoagulant effect. Herein we summarize the available evidence for TSOAC reversal using nonspecific and specific reversal agents. We discuss important limitations of existing evidence, which is derived from studies in human volunteers, animal models and in vitro experiments. Studies evaluating the safety and efficacy of reversal agents on clinical outcomes such as bleeding and mortality in patients with TSOAC-associated bleeding are needed.
authors.affiliation: Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Siegal
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: adam.cuker@uphs.upenn.edu.
authors.forename: Adam
authors.initials: A
authors.lastname: Cuker
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects* / Q000494:pharmacology; D000931:Antidotes / Q000009:adverse effects / Q000494:pharmacology*; D000991:Antithrombins / Q000009:adverse effects / Q000494:pharmacology; D004195:Disease Models, Animal; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000494:pharmacology; D006470:Hemorrhage / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans
chemical_list: D000925:Anticoagulants; D000931:Antidotes; D000991:Antithrombins; D065427:Factor Xa Inhibitors