[Reversal of direct oral anticoagulants: what about new treatments available?]

In cases of severe bleeding on direct oral anticoagulant (DOAC) therapy, several hemostatic agents can be used with varying levels of evidence, including fresh frozen plasma and prothrombin complex concentrates. Recently, we have seen the emergence of specific antidotes to DOAC, such as idarucizumab and andexanet alfa, effective on anti-II and anti-Xa DOAC respectively. These new molecules have shown excellent biological efficacy, hence supporting their use in clinical practice, however they are not routinely used, mainly due to limited availability and high cost. Ciraparantag, an antagonist of DOAC and heparins currently in phase III trials, could become a key molecule in the future considering encouraging preliminary results.