ArticleResearch and practice in thrombosis and haemostasis2026
A UK-wide analysis of the use of reversal agents in 198 patients on direct oral anticoagulants prior to urgent procedures.
Article in Research and practice in thrombosis and haemostasis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Perioperative management of direct oral anticoagulant-treated patients who need urgent surgery.Research and practice in thrombosis and haemostasis · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Direct oral anticoagulants (DOACs) are widely prescribed but present challenges when patients require urgent invasive procedures. While idarucizumab is licensed for preprocedural reversal of dabigatran, 4-factor prothrombin complex concentrates (4F-PCCs) are often used off-label for oral factor (F)Xa inhibitors. Objectives: We aimed to describe real-world UK use of reversal agents prior to urgent procedures. Methods: We conducted a UK-wide audit of adults receiving andexanet alfa, idarucizumab, or 4F-PCC to reverse apixaban, dabigatran, edoxaban, or rivaroxaban, before urgent procedures between October 2020 and June 2023. Data were collected by members of HaemSTAR, a UK-wide network led by hematology resident doctors. Primary outcomes were (1) receipt of reversal ≤24 hours before procedure and (2) adherence to recommended dosing. Secondary outcomes included procedural bleeding risk, 90-day mortality, and 30-day thrombosis rate. Results: Data were collected on 198 patients, with 48% undergoing high-risk procedures. Median time from reversal to procedure was 1.6 hours and 76% took place within 24 hours. 4F-PCC was used in 87%, idarucizumab in 8%, and andexanet alfa in 5%. Tranexamic acid was administered in 20%, 90-day mortality was 24%, and thromboembolic events occurred in 3%, all following 4F-PCC. Conclusion: Reversal agents are frequently used prior to urgent procedures in direct oral anticoagulant-treated patients, including for low-risk interventions. There is limited evidence to support the off-label use of 4F-PCC; the risks, benefits, and cost effectiveness are uncertain. Delays to intervention, low use of tranexamic acid, and infrequent drug-level testing highlight opportunities to improve clinical workflows and inform future trials.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.