McMaster University, Hamilton, Ontario, Canada.
University of Pennsylvania, Philadelphia, PA, United States.
Kardiol Pol. 2019;77(1):3-11. doi: 10.5603/KP.a2018.0197. Epub 2018 Oct 19.
The direct oral anticoagulants (DOACs), or non-vitamin K antagonist oral anticoagulants (NOACs), including dabigatran, which inhibits thrombin, as well as rivaroxaban, apixaban, edoxaban, and betrixaban, which inhibit coagulation factor Xa, are as-sociated with similar or lower risk of bleeding compared with warfarin. The need for reversal of their anticoagulant effect may occur in patients with life-threatening bleeding or those requiring urgent surgery. Currently, the only specific reversal agent for dabigatran, idarucizumab, is widely available, while andexanet alfa, which reverses factor Xa inhibitors, was approved in the United States in May 2018. Ciraparantag, which has been designed to reverse all DOACs and other anticoagulants, is being investigated in clinical trials. In the absence of licensed reversal agents for the oral factor Xa inhibitors, prothrombin complex concentrates are suggested in patients with life-threatening bleeding. Vitamin K and fresh frozen plasma should not be used to reverse DOACs. This review presents the current evidence regarding bleeding risk on DOACs and the reversal strategies to provide guidance on the management of patients treated with DOACs, who experience serious bleeding.
直接口服抗凝剂（DOACs），或非维生素 K 拮抗剂口服抗凝剂（NOACs），包括达比加群，它抑制凝血酶，以及利伐沙班、阿哌沙班、依度沙班和贝曲沙班，它们抑制凝血因子 Xa，与华法林相比，出血风险相似或更低。在危及生命的出血或需要紧急手术的患者中，可能需要逆转其抗凝作用。目前，达比加群的唯一特定逆转剂依达鲁单抗广泛可用，而 2018 年 5 月在美国批准了用于逆转 Xa 因子抑制剂的andexanet alfa。西拉帕他旨在逆转所有 DOAC 和其他抗凝剂，正在临床试验中进行研究。在没有口服 Xa 因子抑制剂的许可逆转剂的情况下，对于有危及生命的出血的患者，建议使用凝血酶原复合物浓缩物。维生素 K 和新鲜冷冻血浆不应用于逆转 DOACs。这篇综述介绍了 DOACs 的出血风险和逆转策略的现有证据，为接受 DOACs 治疗且出现严重出血的患者的管理提供指导。
