Idarucizumab reversal2/15/2024 Two specific DOAC reversal agents have been approved by the US FDA: idarucizumab (Praxbind, Boehringer Ingelheim) for reversal of dabigatran and andexanet alfa for reversal of apixaban and rivaroxaban. Two DOACs, along with warfarin, are among the top ten drugs contributing to emergency department visits in the US. Major bleeding was reported in 2.1% to 3.6% of patients randomized to treatment with a DOAC in phase III clinical trials. 9, 10 Nevertheless, patients taking DOACs may present with serious bleeding or need for an urgent unplanned procedure. Two key advantages of the DOACs compared with VKAs are a reduced incidence of major bleeding and simplified perioperative management. 1- 5 As a class, DOACs have now eclipsed vitamin K antagonists (VKAs) as the most widely prescribed oral anticoagulants in the Unites States and elsewhere. Collectively, these agents have been approved by the United States Food and Drug Administration (US FDA) for prevention of stroke and systemic embolism in non-valvular atrial fibrillation, prevention and treatment of venous thromboembolism (VTE), and secondary prevention of arterial ischemic events in patients with chronic coronary or peripheral artery disease. The direct oral anticoagulants (DOACs) comprise the direct thrombin inhibitor, dabigatran, and the direct factor Xa inhibitors, apixaban, betrixaban, edoxaban, and rivaroxaban. Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum
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