Measurement and reversal of the direct oral anticoagulants

Research output: Contribution to journalReview articlepeer-review

60 Scopus citations

Abstract

Direct oral anticoagulants (DOACs) offer noninferior efficacy and improved safety compared to vitamin K antagonists (VKAs) for the prevention and treatment of venous thromboembolism and for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Unlike VKAs, DOACs do not require routine laboratory monitoring of anticoagulant effect and dose adjustment. In certain situations, however, laboratory assessment of anticoagulant effect may be desirable. Here we review the utility of currently available assays for assessment of DOAC effect and recommend an optimal assessment strategy for each drug, including calibrated dilute thrombin time or ecarin-based assays for dabigatran and calibrated anti-Xa activity assays for the factor Xa inhibitors. We also discuss reversal strategies, both specific and nonspecific, for each drug, including the preferential use of idarucizumab for the reversal of dabigatran and two agents, andexanet and ciraparantag, currently under development for the reversal of rivaroxaban, apixaban, and edoxaban.

Original languageEnglish (US)
Pages (from-to)77-84
Number of pages8
JournalBlood Reviews
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Keywords

  • Apixaban
  • DOACs
  • Dabigatran
  • Edoxaban
  • Measurement
  • Reversal
  • Rivaroxaban

ASJC Scopus subject areas

  • Hematology
  • Oncology

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