Anticoagulant reversal refers to the process of stopping the effect of anticoagulant medications in order to reduce the risk of bleeding or to treat bleeding complications that have already occurred.
The different types of anticoagulant medication: warfarin, heparin, and direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban, and apixaban.
The reversal agents for anticoagulants depend on the type of medication involved.
Warfarin can be reversed with fresh frozen plasma, vitamin K, and prothrombin complex concentrates.
Heparin can be reversed with protamine sulfate.
DOACs have specific reversal agents approved by the FDA, such as idarucizumab for dabigatran, andexanet alfa for rivaroxaban, edoxaban and apixaban.
Prothrombin complex, concentrate and activated prothrombin complex at concentrate, which are non-specific pro hemostatic agents can be used to reverse the effects of all DOACs.
DOAC reversal agents are all very expensive ranging from four to $12,000.
Andexanet administered in patients with intracerebral hemorrhage found it had a better hemostatic efficacy compared with usual care of 67% versus 53.1% but was associated with an increasing ischemic stroke and thrombotic events of 10.3% versus 5.6%;the drug should be administered with caution in patients with prior stroke or thrombosis