Why the study?
Increases in DOAC prescribing led to drug-specific reversal agents, but clinical trials lacked comparator arms, leaving their clinical superiority over nonspecific reversal agents unclear.
Are drug-specific reversal agents clinically superior to nonspecific reversal agents in patients with DOAC-associated intracranial hemorrhage?
Are drug-specific reversal agents clinically superior to nonspecific reversal agents in patients with DOAC-associated intracranial hemorrhage?
While drug-specific DOAC reversal agents are effective for DOAC-associated ICH, further research with comparator arms is needed to establish their superiority over nonspecific agents.
Both specific and nonspecific agents remain reasonable now for DOAC-ICH; leaves open whether targeted reversal should be preferred.
PURPOSE OF REVIEW: This review focuses on recent relevant literature that examines the reversal of direct oral anticoagulants (DOACs) in patients with intracranial hemorrhage (ICH). The aim of this review is to provide an insightful description of available reversal agents and their clinical utility. RECENT FINDINGS: Increases in prescribing of DOACs has led to the introduction of drug-specific reversal agents. The clinical trials that evaluated these agents did not include a comparator arm making it difficult to determine if they are clinically superior to nonspecific reversal agents. SUMMARY: Numerous options for reversal of DOAC-associated ICH are currently available. Recent clinical trials have demonstrated drug-specific reversal agents are effective in this setting, but additional research is needed to determine whether these agents should be routinely preferred over nonspecific reversal agents.
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Strein et al. (2020) studied this question.
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