This time, we review the current options for emergent reversal of DOACs (direct oral anticoagulants) for a major, life threatening bleed. Plus, we discuss some recent literature published regarding use of PCCs (pro-thrombin complex concentrate) and andexanet alfa. In summary, emergent reversal of DOACs in major bleeding is clear as mud.
*Connolly SJ, Crowther M, Eikelboom JW, et al. Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med. 2019;380:1326-35.
*Peled H, Dau NQ, Lau H. Key points to consider when evaluating Andexxa for formulary addition. Neurocrit Care. 2019. https://doi.org/10.1007/s12028-019-00866-6.
*Piran S, Khatib R, Schulman S, et al. Management of direct factor Xa inhibitor-related major bleeding with prothrombin complex concentrate: a meta-analysis. Blood Advances. 2019;3(2):158-167.
*Kaide CG, Gulseth MP. Current strategies for the management of bleeding associated with direct oral anticoagulants and a review of investigational reversal agents. J Emerg Med. 2019. https://doi.org/10.1016/j.jemermed.2019.10.011.
*Schulman S, Kearon C and. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non‐surgical patients. Journal of Thrombosis and Haemostasis, 3: 692-694. doi:10.1111/j.1538-7836.2005.01204.x
*Khorsand N, Majeed A, Sarode R, et al. Assessment of effectiveness of major bleeding management: proposed definitions for effective hemostasis: communication from the SSC of the ISTH. J Thromb Haemost 2016; 14: 211– 4.
***This podcast is intended for healthcare professionals and students only. Materials presented are for informational purposes, not to be used as medical advice or treatment.***