title: Monitoring and reversal strategies for new oral anticoagulants.
abstract: Thrombin inhibitor dabigatran and factor Xa inhibitors rivaroxaban, apixaban and edoxaban form a new class of non-vitamin K antagonist oral anticoagulants and have been extensively studied in patients with venous thromboembolism and atrial fibrillation. They offer anticoagulation that is as effective and at least as safe compared to warfarin without the need for routine laboratory monitoring; however, no reversal strategies are currently validated in case of a non-vitamin K antagonist oral anticoagulant-associated bleed. In emergency situations, laboratory drug measurement and well-defined management for non-vitamin K antagonist oral anticoagulant-induced hemorrhage may improve clinical outcome. In this review, the merits and limitations of the routine coagulation tests and some of the more specific laboratory assays are compared. Furthermore, prohemostatic measures are reviewed and the recommended strategies in case of bleeding are summarized. Specific reversal agents are currently under development (idarucizumab for dabigatran, andexanet alfa for Xa inhibitors, and PER977 for both Xa- and thrombin inhibitors), which will facilitate clinical management of severe bleeding and emergency surgery.
authors.affiliation: Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: Sophie
authors.initials: S
authors.lastname: Vanden Daelen
authors.forename: Marijke
authors.initials: M
authors.lastname: Peetermans
authors.forename: Thomas
authors.initials: T
authors.lastname: Vanassche
authors.forename: Peter
authors.initials: P
authors.lastname: Verhamme
authors.forename: Erik
authors.initials: E
authors.lastname: Vandermeulen
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001777:Blood Coagulation / Q000187:drug effects*; D006470:Hemorrhage / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: andexanet; antidote; apixaban; bleeding; dabigatran; idarucizumab; monitoring; oral anticoagulants; reversal strategies; rivaroxaban