title: Clinical implications of reversal agents for direct oral anticoagulants.
abstract: Direct oral anticoagulants (DOACs) are effective in preventing and treating venous thromboembolism, and preventing stroke in atrial fibrillation. Until recently, there has been no specific reversal agent for DOACs. Now, a specific antidote for the direct thrombin inhibitor, dabigatran has been approved for use, and antidotes for factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) are being developed. We review the evidence for currently used and emerging reversal strategies, and discuss possible clinical implications, including increased prescription of DOACs, use of DOACs in clinical situations previously felt to pose too great a risk of bleeding, and use of reversal agents beyond currently approved indications.
authors.affiliation: Population Health Research Institute, Hamilton, Canada.|Monash University, Melbourne, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Monagle
authors.affiliation: Population Health Research Institute, Hamilton, Canada.|Department of Medicine, McMaster University, Hamilton, Canada.
authors.forename: John W
authors.initials: JW
authors.lastname: Eikelboom
authors.affiliation: Population Health Research Institute, Hamilton, Canada.|Department of Medicine, McMaster University, Hamilton, Canada.
authors.forename: Kuan H
authors.initials: KH
authors.lastname: Ng
authors.affiliation: Population Health Research Institute, Hamilton, Canada.|Department of Medicine, McMaster University, Hamilton, Canada.
authors.forename: Vinai C
authors.initials: VC
authors.lastname: Bhagirath
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000494:pharmacology; D000925:Anticoagulants; D000991:Antithrombins; D001120:Arginine / Q000031:analogs & derivatives / Q000494:pharmacology; D000069604:Dabigatran / Q000037:antagonists & inhibitors*; D015951:Factor Xa / Q000494:pharmacology; D065427:Factor Xa Inhibitors; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D010879:Piperazines / Q000494:pharmacology; D011720:Pyrazoles / Q000037:antagonists & inhibitors*; D011725:Pyridines / Q000037:antagonists & inhibitors*; D011728:Pyridones / Q000037:antagonists & inhibitors*; D011994:Recombinant Proteins / Q000494:pharmacology; D000069552:Rivaroxaban / Q000037:antagonists & inhibitors*; D013844:Thiazoles / Q000037:antagonists & inhibitors*; D054556:Venous Thromboembolism / Q000188:drug therapy
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; C580915:PRT064445; D010879:Piperazines; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D011994:Recombinant Proteins; D013844:Thiazoles; C522181:apixaban; D001120:Arginine; C000594745:idarucizumab; D000069552:Rivaroxaban; D015951:Factor Xa; D000069604:Dabigatran; C552171:edoxaban; C000593571:PER977
keywords: DOAC; NOAC; andexanet alfa; antidote; bleeding; ciraparantag; idarucizumab