Interruption and Reversal of Direct Oral Anticoagulants in Preprocedural and Acute Settings

Abhishek Kulkarni, MD, FAAC; Megha Manek, MD


J Am Board Fam Med. 2018;31(5):817-827. 

In This Article

Abstract and Introduction


With increasing physician and patient awareness, the use of direct oral anticoagulants (DOACs) has been steadily increasing in recent years. Unfortunately, given their recent introduction, the reversal of anticoagulation attained with DOACs is not well studied. Given the diverse mechanisms of action of these newer agents, no universal antidote is available for reversal. Laboratory assays that can accurately quantify the anticoagulation status of patients on DOAC therapy are not readily available, which presents a challenge in situations demanding rapid reversal. Furthermore, the safety and efficacy of reversal agents have not been extensively investigated in the clinical setting.

This review briefly summarizes commercially available DOACs, delineates current knowledge related to reversal of DOAC agents in specific clinical settings, and identifies areas of future study.


New direct oral anticoagulants (DOACs) have emerged as a popular alternative to traditional vitamin K antagonists (VKAs) across several clinical settings. New DOACs accounted for 62% of all new prescriptions in the United States and 98% of all anticoagulant-related costs between 2010 and 2013.[1] The commercially available DOACS in the United States are apixaban, dabigatran, rivaroxaban, betrixaban, and edoxaban. As DOAC-based anticoagulation becomes more prevalent, so does the need for appropriate reversal strategies and antidotes.