This review highlights the 2019 Anticoagulation Forum guideline recommendations for managing DOAC-associated bleeding using specific reversal agents like idarucizumab and andexanet alfa.
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Enables protocolized reversal of life-threatening DOAC bleeds now; extends 2017-18 guidelines that lacked andexanet dosing.
The 2019 guideline from the Anticoagulation Forum provides clear instructions on how to use 2 agents for reversing the effects of direct oral anticoagulants (DOACs): idarucizumab for dabigatran-associated bleeding and andexanet alfa for bleeding associated with rivaroxaban and apixaban. The guideline also discusses off-label use of andexanet alfa for bleeding associated with edoxaban and betrixaban and the use of hemostatic agents such as activated prothrombin complex concentrate and 4-factor prothrombin complex concentrate. Lastly, it offers approaches for building and managing stewardship programs at the health system level.
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Gorr et al. (2021) studied this question.
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