This review highlights current and emerging targeted reversal agents, such as idarucizumab, for managing emergency bleeding or urgent procedures in patients on non-vitamin K antagonist oral anticoagulants.
Idarucizumab supports emergency dabigatran reversal; leaves open questions on completing development for other NOACs.
Nonvitamin K antagonist oral anticoagulants have advantages compared with warfarin, but both types of anticoagulants come with uncertainty about how best to manage life-threatening bleeding events, urgent surgeries, and invasive procedures. Nurse practitioners and physician assistants may need to manage such emergency situations in the critical care setting. Achieving hemostasis quickly is key, and efforts to do so have relied mainly on blood products. Targeted reversal agents are in clinical development and one, idarucizumab, which reverses dabigatran anticoagulation, has been approved. Current options for managing events and urgent procedures in anticoagulated patients are discussed in this article, with a focus on specific reversal agents.
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Singer et al. (2017) studied this question.
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