Interruption and Reversal of Direct Oral Anticoagulants in Preprocedural and Acute Settings

Area of Science:

• Pharmacology
• Hematology
• Clinical Medicine

Background:

• Direct oral anticoagulants (DOACs) are increasingly prescribed for anticoagulation.
• Limited data exists on the reversal of DOACs due to their recent introduction.
• Diverse mechanisms of action preclude a universal antidote for DOAC reversal.

Purpose of the Study:

• To review commercially available DOACs.
• To summarize current knowledge on DOAC reversal in clinical settings.
• To identify areas for future research in DOAC reversal.

Main Methods:

• Literature review of DOACs and their reversal agents.
• Analysis of current clinical guidelines and studies on DOAC reversal.
• Identification of knowledge gaps in DOAC reversal safety and efficacy.

Main Results:

• Commercially available DOACs include Factor Xa inhibitors and direct thrombin inhibitors.
• Specific reversal agents exist for some DOACs, but universal antidotes are lacking.
• Accurate laboratory assays for DOAC levels are not widely available, complicating urgent reversal.

Conclusions:

• Reversal of DOACs presents significant clinical challenges.
• The safety and efficacy of current reversal strategies require further investigation.
• Future research should focus on developing universal antidotes and standardized laboratory monitoring for DOACs.