Reversal of oral anticoagulation in emergency conditions

Abstract

Anticoagulation is the mainstay of prevention and treatment of thromboembolic phenomena and is a life-saving therapy involving a very high number of people in the world. However, the mechanisms by which anticoagulants provide beneficial effects to the cure of patients also cause an increase in bleeding risk. The availability of antidotes for the reversal of their anticoagulant effects is extremely important. In this commentary, we review all the available and approved antidotes of oral anticoagulant drugs, either vitamin K antagonists (i.e., vitamin K + 4F-PCC) or direct anti-IIa and anti-Xa agents (i.e., idarucizumab or andexanet alfa, respectively). We also describe the indications and modalities of their use in emergency, in patients with intracranial hemorrhage (ICH) or severe gastrointestinal (GI) bleeding.