The impact of prothrombin complex concentrates when treating DOAC-associated bleeding: a review

Int J Emerg Med. 2018 Dec 3;11(1):55. doi: 10.1186/s12245-018-0215-6.


Background: Bleeding complications are a risk associated with all anticoagulants. Currently, the treatment options for the management of direct oral anticoagulant (DOAC)-associated bleeding are limited. Prothrombin complex concentrates (PCCs) have been proposed as a potential therapeutic option, and evidence regarding their use is increasing.

Review: Many studies supporting PCC have used preclinical models and healthy volunteers; however, more recently, observational studies have further improved insight into current DOAC reversal strategies. Multiple clinical practice guidelines now specifically suggest use of PCCs for this indication. Specific reversal agents for Factor Xa inhibitors may become available in the near future, but data on their efficacy are still emerging.

Conclusions: Ultimately, a multimodal approach may be the optimal strategy to restore haemostasis in patients presenting with DOAC-associated coagulopathy.

Keywords: Anticoagulant reversal; Anticoagulants; Apixaban; Dabigatran; Edoxaban; Haemorrhage; Non-vitamin K antagonist oral anticoagulants; Prothrombin complex concentrates; Rivaroxaban.

Publication types

  • Review