title: New Oral Anticoagulants and Their Reversal.
abstract: The advent of new oral anticoagulants (NOAC) has increased the armamentarium against thromboembolic diseases but has given rise to a conundrum on their reversal. NOAC's have comparable efficacy to traditional vitamin K antagonists with similar rates of major bleeding. However there is no standardized method for reversal of these agents and no specific antidote. This is of concern not only in acute bleeding episodes but also in clinical scenarios where emergency surgery is required. Recent studies have investigated reversal of dabigatran, rivaroxaban, and apixaban using prothrombin complex concentrates (PCC), recombinant factor VIIa, and in the case of dabigatran, a monoclonal antibody. These studies have been encouraging in showing improvement of bleeding times and blood loss in most models, especially with the use of PCCs and the dabigatran antibody. Of note the majority of common currently used coagulation assays may not correlate with clinical reversal. The management of overt bleeding with NOACs is difficult due to the lack of clinical trials. Current animal trials, case reports and hemostatic testing on human blood have shown some promise; provide guidance but warrant further investigation.
authors: Ian
authors: I
authors: Pinto
authors: Anshu
authors: A
authors: Giri
authors: Umbreen
authors: U
authors: Arshad
authors: State University of New York, 750 E Adams Street, Syracuse, NY 13210, USA. pintoi@upstate.edu.
authors: Ajeet
authors: A
authors: Gajra
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D000931:Antidotes / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D017558:Elective Surgical Procedures; D004630:Emergencies; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D019990:Perioperative Care; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000931:Antidotes