Managing reversal of direct oral anticoagulants in emergency situations: Anticoagulation education task force white paper

Walter Ageno, Harry R. Büller, Anna Falanga, Werner Hacke, Jeroen Hendriks, Trudie Lobban, Jose Merino, Ivan S. Milojevic, Francisco Moya, H. Bart van der Worp, Gary Randall, Konstantinos Tsioufis, Peter Verhamme, A. John Camm

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Anticoagulation is the cornerstone of prevention and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation (AF). However, the mechanisms by which anticoagulants confer therapeutic benefit also increase the risk of bleeding. As such, reversal strategies are critical. Until recently, the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, apixaban, and edoxaban lacked a specific reversal agent. This report is based on findings from the Anticoagulation Education Task Force, which brought together patient groups and professionals representing different medical specialties with an interest in patient safety and expertise in AF, VTE, stroke, anticoagulation, and reversal agents, to discuss the current status of anticoagulation reversal and fundamental changes in management of bleeding associated with DOACs occasioned by the approval of idarucizumab, a specific reversal agent for dabigatran, as well as recent clinical data on specific reversal agents for factor Xa inhibitors. Recommendations are given for when there is a definite need for a reversal agent (e. g. in cases of life-threatening bleeding, bleeding into a closed space or organ, persistent bleeding despite local haemostatic measures, and need for urgent interventions and/or interventions that carry a high risk for bleeding), when reversal agents may be helpful, and when a reversal agent is generally not needed. Key stakeholders who require 24–7/around-the-clock access to these agents vary among hospitals; however, from a practical perspective the emergency department is recommended as an appropriate location for these agents. Clearly, the advent of new agents requires standardised protocols for treating bleeding on an institutional level.

Original languageEnglish
Pages (from-to)1003-1010
Number of pages8
JournalThrombosis and Haemostasis
Volume116
Issue number6
DOIs
Publication statusPublished - Nov 2016
Externally publishedYes

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Reversal agents
  • Stroke prevention
  • Venous thromboembolism

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    Ageno, W., Büller, H. R., Falanga, A., Hacke, W., Hendriks, J., Lobban, T., Merino, J., Milojevic, I. S., Moya, F., van der Worp, H. B., Randall, G., Tsioufis, K., Verhamme, P., & Camm, A. J. (2016). Managing reversal of direct oral anticoagulants in emergency situations: Anticoagulation education task force white paper. Thrombosis and Haemostasis, 116(6), 1003-1010. https://doi.org/10.1160/TH16-05-0363