Antidotes for Anticoagulation Reversal

“Drs. Bianca Rocca and Hugo ten Cate review current strategies for anticoagulation reversal in major bleeding events or urgent surgery as well as specific antidotes, limits of available evidence, thrombotic risks, unmet therapeutic needs, and ongoing research.”

“This is a comprehensive review of anticoagulant reversal. It confirms that: Warfarin: 4F-PCC plus vitamin K remains the gold standard. Dabigatran: Idarucizumab is highly effective and remains the preferred specific antidote. Factor Xa inhibitors: Andexanet provides better laboratory reversal and improved haemostasis but at the cost of increased thrombotic risk, uncertain mortality benefit, high cost and regulatory concerns. 4F-PCC remains the preferred antidote.”