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Review
. 2017 Jan;31(1):77-84.
doi: 10.1016/j.blre.2016.08.006. Epub 2016 Sep 2.

Measurement and reversal of the direct oral anticoagulants

Bethany T Samuelson  1 , Adam Cuker  2
Affiliations
Review

Measurement and reversal of the direct oral anticoagulants

Bethany T Samuelson et al. Blood Rev. 2017 Jan.

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.

Keywords: Apixaban; DOACs; Dabigatran; Edoxaban; Measurement; Reversal; Rivaroxaban.

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Conflict of interest statement

Statement BTS has no conflicts of interest to disclose.

References

    1. Chai-Adisaksopha C, Crowther M, Isayama T, Lim W. The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis. Blood. 2014;124:2450–2458. - PubMed
    1. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149:315–352. - PubMed
    1. Burnett AE, Mahan CE, Vazquez SR, Oertel LB, Garcia DA, Ansell J. Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis. 2016;41:206–232. - PMC - PubMed
    1. Eby C. Novel anticoagulants and laboratory testing. Int J Lab Hematol. 2013;35:262–268. - PubMed
    1. Ezekowitz MD, Reilly PA, Nehmiz G, Simmers TA, Nagarakanti R, Parcham-Azad K, et al. Dabigatran with or without concomitant aspirin compared with warfarin alone in patients with nonvalvular atrial fibrillation (PETRO Study) Am J Cardiol. 2007;100:1419–1426. - PubMed

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