Thromb Haemost 2016; 116(06): 1003-1010
DOI: 10.1160/TH16-05-0363
Anticoagulation Education Task Force White Paper
Schattauer Publishers Schattauer

Managing reversal of direct oral anticoagulants in emergency situations

Anticoagulation Education Task Force White Paper
Walter Ageno
1   University of Insubria, Varese, Italy
,
Harry R. Büller
2   Academic Medical Centre, Amsterdam, The Netherlands
,
Anna Falanga
3   Department of Immunohematology & Transfusion Medicine and the Hemostasis and Thrombosis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy
,
Werner Hacke
4   Department of Neurology, Heidelberg University, Heidelberg, Germany
,
Jeroen Hendriks
5   Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, South Australian Health & Medical Research Institute, Adelaide, Australia
6   Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
,
Trudie Lobban
7   Arrhythmia Alliance and AF Association, Hampshire, UK
,
Jose Merino
8   Arrhythmia Research Unit, Universitario La Paz , Madrid, Spain
,
Ivan S. Milojevic
9   General Hospital Cuprija, Cuprija, Serbia
,
Francisco Moya
10   International Medical Services and Emergency Medicine, Vithas-Xanit International Hospital, Benalmadena, Malaga, Spain
,
H. Bart van der Worp
11   Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
,
Gary Randall
12   Stroke Alliance For Europe (SAFE), London, UK
,
Konstantinos Tsioufis
13   First Cardiology Clinic, Hippokration Hospital, University of Athens, Greece
,
Peter Verhamme
14   University of Leuven, Leuven, Belgium
,
A. John Camm
15   Division of Cardiovascular Sciences, St George’s University of London, London, UK
16   ICMS, Imperial College, London, UK
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received 11. Mai 2016

Accepted after major revision: 10. Juli 2016

Publikationsdatum:
09. März 2018 (online)

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Summary

Anticoagulation is the cornerstone of prevention and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation (AF). However, the mechanisms by which anticoagulants confer therapeutic benefit also increase the risk of bleeding. As such, reversal strategies are critical. Until recently, the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, apixaban, and edoxaban lacked a specific reversal agent. This report is based on findings from the Anticoagulation Education Task Force, which brought together patient groups and professionals representing different medical specialties with an interest in patient safety and expertise in AF, VTE, stroke, anticoagulation, and reversal agents, to discuss the current status of anticoagulation reversal and fundamental changes in management of bleeding associated with DOACs occasioned by the approval of idarucizumab, a specific reversal agent for dabigatran, as well as recent clinical data on specific reversal agents for factor Xa inhibitors. Recommendations are given for when there is a definite need for a reversal agent (e.g. in cases of life-threatening bleeding, bleeding into a closed space or organ, persistent bleeding despite local haemostatic measures, and need for urgent interventions and/or interventions that carry a high risk for bleeding), when reversal agents may be helpful, and when a reversal agent is generally not needed. Key stakeholders who require 24–7/around-the-clock access to these agents vary among hospitals; however, from a practical perspective the emergency department is recommended as an appropriate location for these agents. Clearly, the advent of new agents requires standardised protocols for treating bleeding on an institutional level.