Vitamin K antagonists (VKAs), such as warfarin, modify the hepatic synthesis of vitamin K–dependent coagulation factors (factor VII, FX, FIX, FII, protein C, protein S) and are indicated for long-term antithrombotic therapy. In this review, we discuss practical issues in the initiation of DOAC therapy, situations where reversal may be needed, coagulation assays, reversal agents, and post-reversal complications in the context of published evidence and guidelines.Īnticoagulants are used for preventing and treating deep vein thrombosis (DVT), pulmonary embolism (PE), mechanical heart valve thrombosis, cardioembolic events in atrial fibrillation (AF), and acute coronary syndromes. However, specific reversal agents are efficacious and safe and should be preferred when available. Nonspecific prohemostatic agents can counteract the anticoagulant action of DOACs in emergency situations, when specific reversal agents are unavailable. fresh frozen plasma, prothrombin complex concentrate) are available. ciraparantag for heparins, DOACs) are in development. Idarucizumab and andexanet alfa, which reverse the anticoagulant effects of dabigatran and FXa inhibitors, respectively, are DOAC reversal agents available in the US. Clinicians may need to achieve rapid reversal of anticoagulation effects of the DOACs in an emergency setting.
DOACs are associated with lower rates of major and fatal bleeding events compared with warfarin. apixaban, betrixaban, edoxaban, rivaroxaban). Direct oral anticoagulants (DOACs) include dabigatran etexilate, a direct thrombin inhibitor, and specific inhibitors of activated coagulation factor X (FXa e.g.
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