ArticleHematology. American Society of Hematology. Education Program2019
What we have learned about direct oral anticoagulant reversal.
Article in Hematology. American Society of Hematology. Education Program, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Brazilian consensus on the management of bleeding complications related to the use of oral anticoagulants.Revista da Associacao Medica Brasileira (1992) · 2026Guideline
- 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Journal of the American College of Cardiology · 2024Guideline
- Guideline
- Safety of expedited-surgery protocols in anticoagulant-treated patients with hip fracture: a systematic review and meta-analysis.Canadian journal of surgery. Journal canadien de chirurgiePooled it
- Effect of PCC on thrombin generation in patients on FXaI with bleeding or needing urgent surgery (GAUGE).Blood advances · 2026Observational
- TFPIα inhibition by andexanet alfa is partially restored by protein S and factor V-short.Blood advances · 2026Article
- Andexanet alfa for reversal of intracerebral haemorrhage resulting in ST-segment myocardial infarction: a case report.European heart journal. Case reports · 2025Article
- Development of a Medication-Use Evaluation Template for Andexanet Alfa in the Reversal of Anticoagulation With Factor Xa Inhibitors.Journal of pharmacy practice · 2025Article
- Incident thrombocytopenia and bleeding risk in elderly patients with atrial fibrillation on direct oral anticoagulants: insights from the ATHEROsclerosis in Atrial Fibrillation study.Research and practice in thrombosis and haemostasis · 2024Article
- Engineering and evaluation of FXa bypassing agents that restore hemostasis following Apixaban associated bleeding.Nature communications · 2024Article
- A small-molecule hemostatic agent for the reversal of direct oral anticoagulant-induced bleeding.Research and practice in thrombosis and haemostasis · 2024Article
- Effect of PCC on Thrombin Generation among Patients on Factor Xa Inhibitors with Major Bleeding or Needing Urgent Surgery (GAUGE): Design and Rationale.TH open : companion journal to thrombosis and haemostasis · 2023Article
- Prothrombin complex concentrates for DOAC-associated bleeding, global coagulation assays, and assessments of clinical hemostasis: How to gauge the impact?Research and practice in thrombosis and haemostasis · 2020Article
Corrections and comments
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Authors and funding
1 author.
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No grant is acknowledged in the PubMed record.
Abstract
Bleeding is the main complication of oral anticoagulant (OAC) therapy, with major bleeds occurring in about 2% to 4% of OAC-treated patients per year. Although direct oral anticoagulants (DOACs) reduce the risk of major, fatal, and intracranial hemorrhage, major DOAC-related bleeding is associated with substantial morbidity and mortality, with case-fatality rates of 8% to 15% reported. Specific reversal agents for dabigatran (idarucizumab) and factor Xa inhibitors (andexanet) correct laboratory indices of anticoagulant effect. Clinical studies suggest that the majority of patients receiving these agents for DOAC-associated major bleeds experience clinical hemostasis. However, uncertainty remains regarding the incremental benefit of these agents and prothrombin complex concentrates over supportive measures alone, based on cohort studies that lacked control groups. Similar methodologic limitations preclude firm conclusions regarding the harms associated with use of these agents. Importantly, patients with DOAC-related major bleeding have substantial short-term risks of thrombosis and mortality, emphasizing the need for individualized patient assessment and protocolized bleed management strategies that include assessment of candidacy for safe resumption of OACs. With expanding indications and increasing prevalence of DOAC-eligible patients, bleeding complications and their management represent an ever-greater major health problem.
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