Anticoagulation Myth Busters

MYTH

“NOACs cannot be reversed and are therefore unsafe”

REALITY

“Reversal agents are now available idarucizumab for dabigatran and andexanet alfa for apixaban/rivaroxaban.”1,2

However, given the relatively short plasma half-life and rapid offset of action of NOACs compared to warfarin, the duration of any bleeding event is likely to be shorter and less severe and may not necessitate the need for the administration of a specific reversal agent.

If a patient does experience a bleed, the cause and severity should be assessed. If urgent treatment is required, the oral anticoagulant agent (OAC) may be discontinued and supportive measures started; e.g fluid replacement and/or transfusions.3

Prothrombin Complex Concentrate (PCC) can also be used to reverse or partially reverse bleeding.3,4

Refer to local or hospital guidance on management of bleeding on anticoagulant therapy for further information.

 

Agent Approximate half life
Warfarin(12) 40 hours
Dabigatran(7) 13-18 hours
Apixaban(6) 12 hours
Rivaroxaban(9) 5-13 hours
Edoxaban(8) 10-14 hours
REFERENCES
  1. Connolly SJ, Milling TJ, Jr., Eikelboom JW, Gibson CM, Curnutte JT, Gold A, et al. Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2016;375(12):1131-41.
  2. Peetermans M, Pollack C, Jr., Reilly P, Liesenborghs L, Jacquemin M, Levy JH, et al. Idarucizumab for dabigatran overdose. Clin Toxicol (Phila). 2016;54(8):644-6.
  3. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893-962.
  4. Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary. Europace. 2018.
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