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Reversal of direct oral anticoagulants: guidance from the SSC of the ISTH.

Author information

Affiliations

  • 1. Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
      Authors
    • Levy JH 1
    (1 author)
  • 2. Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, Ontario, Canada.
      Authors
    • Shaw JR 2
    (1 author)
  • 3. Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Ontario, Canada.
      Authors
    • Castellucci LA 3
    • Siegal D 3
    (2 authors)
  • 4. Hematology Division Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
      Authors
    • Connors JM 4
    (1 author)
  • 5. Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.
      Authors
    • Douketis J 5
    (1 author)
    • Show all (9)

ORCIDs linked to this article

Show all (6)

Journal of Thrombosis and Haemostasis : JTH, 17 Jul 2024, 22(10):2889-2899
https://doi.org/10.1016/j.jtha.2024.07.009 PMID: 39029742 

Review

Abstract 

The currently approved direct oral anticoagulants (DOACs) are increasingly used in clinical practice. Although serious bleeding risks are lower with DOACs than with vitamin K antagonists, bleeding remains the most frequent side effect. Andexanet alfa and idarucizumab are the currently approved specific reversal agents for oral factor (F)Xa inhibitors and dabigatran, respectively. Our prior guidance document was published in 2016, but with more information available on the utility and increased use of these reversal agents and other bleeding management strategies, we have updated this International Society on Thrombosis and Haemostasis guidance document on DOAC reversal. In this narrative review, we compare the mechanism of action of specific and nonspecific reversal agents, review the clinical data supporting their use, and provide guidance on when reversal is indicated. In addition, we briefly discuss the reversal of oral FXIa inhibitors, a new class of DOACs currently under clinical development.

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Read article at publisher's site: https://doi.org/10.1016/j.jtha.2024.07.009

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