Interruption and reversal of direct oral anticoagulants in preprocedural and acute settings

Abstract

With increasing physician and patient awareness, the use of direct oral anticoagulants (DOACs) has been steadily increasing in recent years. Unfortunately, given their recent introduction, the reversal of anticoagulation attained with DOACs is not well studied. Given the diverse mechanisms of action of these newer agents, no universal antidote is available for reversal. Laboratory assays that can accurately quantify the anticoagulation status of patients on DOAC therapy are not readily available, which presents a challenge in situations demanding rapid reversal. Furthermore, the safety and efficacy of reversal agents have not been extensively investigated in the clinical setting. This review briefly summarizes commercially available DOACs, delineates current knowledge related to reversal of DOAC agents in specific clinical settings, and identifies areas of future study.