Alejandro Lazo-Langner, Eddy S Lang, James Douketis Critical Care 2013, 17:230 (17 June 2013)
New oral anticoagulants including dabigatran, rivaroxaban and apixaban have been recently approved for primary and secondary prophylaxis of thromboembolic conditions. However, no clear strategy exists for managing and reversing their anticoagulant effects. We aimed to summarize the available evidence for clinical management and reversal of bleeding associated with new oral anticoagulants…
Using a systematic review approach we aimed to identify studies describing reversal strategies for dabigatran, rivaroxaban and dabigatran. The search was conducted using Medline, EMBASE, HealthSTAR, and grey literature. We included laboratory and human studies. Out of 106 potentially relevant references, we included 23 studies reported in 37 references. Four studies were conducted in humans and the rest were in vitro and in vivo studies. The majority of the studies evaluated the use of prothrombinase complex concentrate (PCC) either activated or inactivated, and recombinant activated factor VII (rFVIIa). Other interventions were also identified. Laboratory studies suggest than hemostatic parameters and bleeding might be partially or completely corrected by PCC for rivaroxaban better than dabigatran. Studies in humans suggest that PCC might reverse the effects of rivaroxaban better than dabigatran assessed by hemostatic tests. We were not able to locate studies evaluating the clinical efficacy of these agents. Best available evidence suggests that PCC (activated or inactivated) might be the best option for reversing new anticoagulants. Evidence for rFVIIa is less compelling. There might be differences in the efficacy of reversing agents for different anticoagulants. Studies assessing clinical efficacy of these reversal agents are needed.
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