Management of Major Bleeding with the Non-Vitamin K Oral Anticoagulants: the Role of Antidotes
Keywords:atrial fibrillation, anticoagulation, non-vitamin K anticoagulants, dabigatran, rivaroxaban, apixaban, edoxaban, intracerebral hemorrhage, bleeding, antidotes, idarucizumab, andexanet, aripazine
AbstractOver the recent years, new oral anticoagulant agents have been developed and entered the clinical arena, the direct or non-vitamin K oral anticoagulants (NOACs). Although more expensive, these agents have been proven as equivalent or superior to vitamin K antagonists in the treatment of non-valvular atrial fibrillation (AF) and venous thrombo-embolism with a lower incidence of intracerebral hemorrhage. Nevertheless, occurrence of major or life-threatening bleeding events is still quite possible. Thus, there is a major concern regarding the lack of a specific antidote and rapid reversal agent in such disastrous situations. Fortunately, the development of effective specific NOAC antidotes has recently made great advances, which are herein briefly reviewed.
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