Reversal agents for non-vitamin K antagonist oral anticoagulants

Key PointsThe non-vitamin K antagonist oral anticoagulants (NOACs) include dabigatran, which inhibits thrombin, and apixaban, betrixaban, edoxaban, and rivaroxaban, which inhibit factor XaThree NOAC reversal agents are in various stages of development: idarucizumab is licensed in many countries, andexanet is under consideration by regulatory agencies, and ciraparantag is undergoing phase III evaluationIdarucizumab is approved for dabigatran reversal in patients requiring emergency surgery or urgent procedures and in those with life-threatening or uncontrolled bleedingIn the absence of licensed reversal agents for the oral factor Xa inhibitors, prothrombin complex concentrates are increasingly used in patients taking these agents who present with life-threatening bleeding