Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
  • CME/MOC
    • Articles
    • Calendar
  • COVID-19
    • Curbside Consults Overview
    • Pulmonary/ICU
    • Patient Subsets & Specific Organ Involvement
    • Therapies
    • Imaging & Procedures
    • Patients with Underlying Disease
    • Virus Background & Testing
    • Healthcare System Practice
  • Info For
    • Manuscript Submission
      • 1-Minute Consult
      • Commentary
      • Current Drug Therapy
      • Editorial
      • Guidelines to Practice
      • Interpreting Key Trials
      • Letter to the Editor
      • Review
      • Smart Testing
      • Symptoms to Diagnosis
      • The Clinical Picture
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
  • Conference Coverage
    • ASH Annual Meeting
    • AHA Sessions 2020
    • IDWeek 2020
    • CHEST 2020
    • ADA 2020
    • ACC 2020
  • Advertise
    • Media Kit
    • Contact
  • Other Publications
    • www.clevelandclinic.org

User menu

  • Register
  • Log in

Search

  • Advanced search
Cleveland Clinic Journal of Medicine
  • Other Publications
    • www.clevelandclinic.org
  • Register
  • Log in
Cleveland Clinic Journal of Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
  • CME/MOC
    • Articles
    • Calendar
  • COVID-19
    • Curbside Consults Overview
    • Pulmonary/ICU
    • Patient Subsets & Specific Organ Involvement
    • Therapies
    • Imaging & Procedures
    • Patients with Underlying Disease
    • Virus Background & Testing
    • Healthcare System Practice
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
  • Conference Coverage
    • ASH Annual Meeting
    • AHA Sessions 2020
    • IDWeek 2020
    • CHEST 2020
    • ADA 2020
    • ACC 2020
  • Advertise
    • Media Kit
    • Contact
Guidelines to Practice

Reversal of direct oral anticoagulants: Highlights from the Anticoagulation Forum guideline

Haeshik S. Gorr, MD, Lucy Yun Lu, PharmD, MS and Eric Hung, PharmD, CACP, AE-C
Cleveland Clinic Journal of Medicine February 2021, 88 (2) 98-103; DOI: https://doi.org/10.3949/ccjm.88a.19133
Haeshik S. Gorr
Department of Medicine, Hennepin Healthcare; Assistant Professor of Medicine, University of Minnesota Medical School, Minneapolis, MN
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: Haeshik.gorr@hcmed.org
Lucy Yun Lu
Department of Pharmacy, Hennepin Healthcare, Minneapolis, MN; Clinical Associate Professor, College of Pharmacy, University of Minnesota, Minneapolis, MN
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Eric Hung
Department of Pharmacy, Hennepin Healthcare, Minneapolis, MN; Clinical Pharmacist, People’s Center Clinics & Services, Minneapolis, MN; Adjunct Professor, Department of Nursing, St. Catherine University, St. Paul, MN
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

ABSTRACT

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.

  • Copyright © 2021 The Cleveland Clinic Foundation. All Rights Reserved.
View Full Text

REFERENCES

  1. ↵
    1. Connolly SJ,
    2. Ezekowitz MD,
    3. Yusuf S, et al
    . Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361(12):1139–1151. doi:10.1056/NEJMoa0905561
    OpenUrlCrossRefPubMed
    1. Patel MR,
    2. Mahaffey KW,
    3. Garg J, et al
    . Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365(10):883–891. doi:10.1056/NEJMoa1009638
    OpenUrlCrossRefPubMed
  2. ↵
    1. Granger CB,
    2. Alexander JH,
    3. McMurray JJ, et al
    . Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365(11):981–992. doi:10.1056/NEJMoa1107039
    OpenUrlCrossRefPubMed
  3. ↵
    1. Tomaselli GF,
    2. Mahaffey KW,
    3. Cuker A, et al
    . 2017 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2017; 70(24):3042–3067. doi:10.1016/j.jacc.2017.09.1085
    OpenUrlFREE Full Text
  4. ↵
    1. Douketis JD,
    2. Spyropoulos AC,
    3. Spencer FA, et al
    . Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 suppl):e326S–e350S. doi:10.1378/chest.11-2298
    OpenUrlCrossRefPubMed
  5. ↵
    1. Cuker A,
    2. Burnett A,
    3. Triller D, et al
    . Reversal of direct oral anticoagulants: guidance from the Anticoagulation Forum. Am J Hematol 2019; 94(6):697–709. doi:10.1002/ajh.25475
    OpenUrlCrossRefPubMed
  6. ↵
    1. Pollack CV Jr.,
    2. Reilly PA,
    3. van Ryn J, et al
    . Idarucizumab for dabigatran reversal—full cohort analysis. N Engl J Med 2017; 377(5):431–441. doi:10.1056/NEJMoa1707278
    OpenUrlCrossRefPubMed
  7. ↵
    1. Connolly SJ,
    2. Crowther M,
    3. Eikelboom JW, et al
    . Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med 2019; 380(14):1326–1335. doi:10.1056/NEJMoa1814051
    OpenUrlCrossRefPubMed
  8. ↵
    1. Varadi K,
    2. Tangada S,
    3. Loeschberger M, et al
    . Pro- and anticoagulant factors facilitate thrombin generation and balance the haemostatic response to FEIBA(®) in prophylactic therapy. Haemophilia 2016; 22(4):615–624. doi:10.1111/hae.12873
    OpenUrlCrossRef
  9. ↵
    1. Schulman S,
    2. Ritchie B,
    3. Nahirniak S, et al
    . Reversal of dabigatran-associated major bleeding with activated prothrombin concentrate: a prospective cohort study. Thromb Res 2017; 152:44–48. doi:10.1016/j.thromres.2017.02.010
    OpenUrlCrossRef
  10. ↵
    1. Majeed A,
    2. Ågren A,
    3. Holmström M, et al
    . Management of rivaroxaban- or apixaban-associated major bleeding with prothrombin complex concentrates: a cohort study. Blood 2017; 130(15):1706–1712. doi:10.1182/blood-2017-05-782060
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Schulman S,
    2. Gross PL,
    3. Ritchie B, et al
    . Prothrombin Complex Concentrate for Major Bleeding on Factor Xa Inhibitors: a prospective cohort study. Thromb Haemost 2018; 118(5):842–851. doi:10.1055/s-0038-1636541
    OpenUrlCrossRef
  12. ↵
    1. Steffel J,
    2. Verhamme P,
    3. Potpara TS, et al
    . The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 2018; 39(16):1330–1393. doi:10.1093/eurheartj/ehy136
    OpenUrlCrossRefPubMed
  13. ↵
    1. Baxalta US Inc
    . Feiba (anti-inhibitor coagulant complex). Highlights of prescribing information. February 2020. Accessed January 25, 2021. https://www.shirecontent.com/PI/PDFs/FEIBA_USA_ENG.pdf
  14. ↵
    1. The Joint Commision
    . National patient safety goal for anticoagulant therapy. https://www.jointcommission.org/-/media/tjc/newsletters/r3_19_anticoagulant_therapy_final2pdf.pdf?db=web&hash=710D79BDAEFFCA6C833BB823E1EEF0C6. Accessed January 25, 2021.
  15. ↵
    1. CRASH-2 trial collaborators,
    2. Shakur H,
    3. Roberts I, et al
    . Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376(9734):23–32. doi:10.1016/S0140-6736(10)60835-5
    OpenUrlCrossRefPubMed
  16. ↵
    1. Garcia D,
    2. Crowther M
    . Management of bleeding in patients receiving direct oral anticoagulants. UptoDate. https://www.uptodate.com/contents/management-of-bleeding-in-patients-receiving-direct-oral-anticoagulants. Accessed January 25, 2021.
  17. ↵
    1. Ansell JE,
    2. Bakhru SH,
    3. Laulicht BE, et al
    . Single-dose ciraparantag safely and completely reverses anticoagulant effects of edoxaban. Thromb Haemost 2017; 117(2):238–245. doi:10.1160/TH16-03-0224
    OpenUrlCrossRefPubMed

This article requires you to have a ccjm.org account to view the full text. If you already have an account, you may log in below to view this article along with all other CCJM content. If you do not have an account, register here. It’s free!

Log in using your username and password

Forgot your user name or password?
PreviousNext
Back to top

Registration is Now Required for Free Access to CCJM Content

Register once and log in for full access to articles and content. Click “Register” in the upper right corner and follow the simple instructions to create a new account.

If you are using a mobile device, click on the settings icon to access the Register link.

In this issue

Cleveland Clinic Journal of Medicine: 88 (2)
Cleveland Clinic Journal of Medicine
Vol. 88, Issue 2
1 Feb 2021
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Cleveland Clinic Journal of Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Reversal of direct oral anticoagulants: Highlights from the Anticoagulation Forum guideline
(Your Name) has sent you a message from Cleveland Clinic Journal of Medicine
(Your Name) thought you would like to see the Cleveland Clinic Journal of Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
2 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Reversal of direct oral anticoagulants: Highlights from the Anticoagulation Forum guideline
Haeshik S. Gorr, Lucy Yun Lu, Eric Hung
Cleveland Clinic Journal of Medicine Feb 2021, 88 (2) 98-103; DOI: 10.3949/ccjm.88a.19133

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Reversal of direct oral anticoagulants: Highlights from the Anticoagulation Forum guideline
Haeshik S. Gorr, Lucy Yun Lu, Eric Hung
Cleveland Clinic Journal of Medicine Feb 2021, 88 (2) 98-103; DOI: 10.3949/ccjm.88a.19133
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Linkedin Share Button

Jump to section

  • Article
    • ABSTRACT
    • ANTICOAGULATION FORUM GUIDELINE
    • MAIN RECOMMENDATIONS OF THE GUIDELINES
    • DIFFERENCES WITH EARLIER GUIDELINES, AND EXPECTED CLINICAL IMPACT
    • OTHER SOCIETIES’ RECOMMENDATIONS
    • SUMMARY
    • DISCLOSURES
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

Similar Articles

Subjects

  • Pulmonology
  • Vascular Medicine
  • Emergency Medicine
  • Drug Therapy
  • Cardiology

Navigate

  • Current Issue
  • Past Issues
  • Supplements
  • Article Type
  • Specialty
  • CME/MOC Articles
  • CME/MOC Calendar
  • Media Kit
  • Advertise Contact

Authors & Reviewers

  • Manuscript Submission
  • Authors & Reviewers
  • Subscriptions
  • Advertisers
  • About CCJM
  • Contact Us
  • Cleveland Clinic Center for Continuing Education
  • Consult QD

Share your suggestions!

Copyright © 2021 The Cleveland Clinic Foundation. All rights reserved. The information provided is for educational purposes only. Use of this website is subject to the website terms of use and privacy policy. 

Powered by HighWire