Guidance on the emergent reversal of oral thrombin and factor Xa inhibitors

Am J Hematol. 2012 May;87 Suppl 1:S141-5. doi: 10.1002/ajh.23202. Epub 2012 Apr 4.


The new oral anticoagulants dabigatran, rivaroxaban and apixaban have advantages over warfarin which include no need for laboratory monitoring, less drug-drug interactions and less food-drug interactions. However, there is no established antidote for patients who are bleeding or require emergent surgery and there is a paucity of evidence to guide the clinical care during these situations. Members of thrombosis and anticoagulation groups participating in the Thrombosis and Hemostasis Summit of North America formulated expert opinion guidance for reversing the anticoagulant effect of the new oral anticoagulants and suggest: routine supportive care, activated charcoal if drug ingestion was within a couple of hours, and hemodialysis if feasible for dabigatran. Also, the pros and cons of the possible use of four factor prothrombin complex concentrate are discussed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Administration, Oral
  • Antidotes / therapeutic use*
  • Blood Coagulation Factor Inhibitors / adverse effects*
  • Blood Coagulation Factor Inhibitors / therapeutic use
  • Blood Coagulation Factors / therapeutic use*
  • Charcoal / therapeutic use*
  • Drug Interactions
  • Drug Monitoring / methods
  • Factor Xa Inhibitors*
  • Hemorrhage / blood
  • Hemorrhage / chemically induced*
  • Hemorrhage / drug therapy*
  • Humans
  • Practice Guidelines as Topic
  • Thrombin / antagonists & inhibitors*


  • Antidotes
  • Blood Coagulation Factor Inhibitors
  • Blood Coagulation Factors
  • Factor Xa Inhibitors
  • Charcoal
  • prothrombin complex concentrates
  • Thrombin