Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum

Am J Hematol. 2019 Jun;94(6):697-709. doi: 10.1002/ajh.25475. Epub 2019 Apr 16.


Two specific reversal agents for direct oral anticoagulants (DOACs) have been approved in the United States: idarucizumab for dabigatran reversal and andexanet alfa for apixaban and rivaroxaban reversal. Non-specific prohemostatic agents such as prothrombin complex concentrate (PCC) and activated PCC have also been used for DOAC reversal. The goal of this document is to provide comprehensive guidance from the Anticoagulation Forum, a North American organization of anticoagulation providers, regarding use of DOAC reversal agents. We discuss indications for reversal, provide guidance on how the individual reversal agents should be administered, and offer suggestions for stewardship at the health system level.

Publication types

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

MeSH terms

  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Factor Xa / therapeutic use*
  • Humans
  • Practice Guidelines as Topic
  • Recombinant Proteins / therapeutic use*


  • Antibodies, Monoclonal, Humanized
  • Anticoagulants
  • PRT064445
  • Recombinant Proteins
  • idarucizumab
  • Factor Xa