The Reversal of Direct Oral Anticoagulants in Animal Models

Honickel, Markus; Akman, Necib; Grottke, Oliver

doi:10.1097/shk.0000000000000848

Cited by 6 publications

(4 citation statements)

References 74 publications

(129 reference statements)

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“…This has led to major guidelines suggesting 4F‐PCC over plasma for reversal of warfarin‐associated major bleeding . Major guidelines also suggest 4F‐PCC be considered for reversal of direct oral anticoagulants (DOACs), although emphasize that data are limited and largely based on preclinical data and studies in healthy volunteers, with no prospective randomized data in patients with DOAC‐associated bleeding yet reported …”

Section: Introductionmentioning

confidence: 99%

Off‐label use of 4‐factor prothrombin complex concentrate is common despite little known benefit: A retrospective study

Scharman

Shatzel

Kim

et al. 2018

European J of Haematology

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Section: Introductionmentioning

confidence: 99%

Off‐label use of 4‐factor prothrombin complex concentrate is common despite little known benefit: A retrospective study

Scharman

Shatzel

Kim

et al. 2018

European J of Haematology

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“…No high-quality data have been published so far investigating different reversal strategies in trauma patients. Most of the available evidence stems from large animal studies in pigs [52][53][54][55]. Patients suffering from major trauma, TBI patients, or those with spinal injuries should receive immediate reversal therapy.…”

Section: Life Threatening Bleeding or Bleeding With Potential Organ D...mentioning

confidence: 99%

Direct oral anticoagulants in trauma patients

Schöchl,

Grottke,

Schmitt

2024

Current Opinion in Anaesthesiology

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Purpose of review Direct oral anticoagulants (DOACs) are increasingly prescribed for prevention of thromboembolic events. Thus, trauma care providers are facing a steadily raising number of injured patients on DOACs. Recent findings Despite a predictable pharmacokinetic profile, the resulting plasma levels of trauma patients upon admission and bleeding risks remain uncertain. Therefore, recent guidelines recommend the measurement of DOAC plasma concentrations in injured patients. Alternatively, DOAC specific visco-elastic tests assays can be applied to identify DOAC patients at bleeding risk. Bleeding complications in trauma patients on DOACs are generally higher compared to nonanticoagulated subjects, but comparable to vitamin K antagonists (VKAs). In particular, a traumatic brain injury does not carry an increased risk of intracranial bleeding due to a DOAK intake compared to VKAs. Current studies demonstrated that up to 14% of patients with a hip fracture are on DOACs prior to surgery. However, the majority can be operated safely within a 24h time window without an increased bleeding rate. Specific antagonists facilitate rapid reversal of patients on DOACs. Idarucizumab for dabigatran, and andexanet alfa for apixaban and rivaroxaban have been approved for life threatening bleeding. Alternatively, prothrombin complex concentrate can be used. Dialysis is a potential treatment option for dabigatran and haemoabsorption with special filters can be applied in patients on FXa-inhibitors. Summary Current guidelines recommend the measurement of DOAC plasma levels in trauma patients. Compared to VKAs, DOACs do not carry a higher bleeding risk. DOAC specific antagonists facilitate the individual bleeding management.

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“…There may be disadvantages of small animal use (rodent and rabbit) such as small animals have low blood volume and might be less suitable for use in trauma studies. The disadvantages of the use of large animals may be the ethical approvals that can be harder to take and standardization of the study may be more difficult [9] .…”

Section: Animal Studies In Doac Researchmentioning

confidence: 99%

“…In terms of the assessment of anticoagulation and its reversal, in the review paper of Honickel et al [9] , it was considered that "bleeding volume" should be regarded as the gold standard of outcomes. The "comparisons of bleeding volume versus bleeding time" have been found as a more sensitive and reliable outcome.…”

Section: Animal Studies In Doac Researchmentioning

confidence: 99%