The development and approval of specific reversal agents for DOACs may increase their prescription and enable their use in clinical situations previously considered too high-risk for bleeding.
May broaden DOAC use in high-bleeding-risk settings; leaves open prospective outcome confirmation.
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.
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Monagle et al. (2017) studied this question.
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