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

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.

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