Clinical guideline on reversal of direct oral anticoagulants in patients with life threatening bleeding
Methodological detailssystematic literature search, GRADE methodology, Delphi consensus, Certainty of evidence low or very low (GRADE C); no published RCTs comparing two active comparators, 35 recommendations and clinical practice statements; strong consensus (>90% agreement) in 97.1%, consensus (75 to 90% agreement) in 2.9%
- Systematic literature search
- GRADE methodology
- Delphi consensus
- Certainty of evidence low or very low (GRADE C); no published RCTs comparing two active comparators
- 35 recommendations and clinical practice statements; strong consensus (>90% agreement) in 97.1%, consensus (75 to 90% agreement) in 2.9%
Recommendations
As issued by the authors
DOAC-specific coagulation monitoring may help in patients at risk for elevated DOAC levels; global coagulation tests are not recommended to exclude clinically relevant DOAC levels
In urgent situations, start haemostatic treatment with direct reversal or nonspecific haemostatic agents without waiting for DOAC level monitoring
DOAC levels above 50 ng ml-1 may be considered clinically relevant, necessitating haemostatic treatment before urgent or emergency procedures
Andexanet alfa not recommended before cardiac surgery under factor Xa (FXa) inhibitors (inhibition of unfractionated heparin needed for extracorporeal circulation)
DOAC overdose without bleeding: no haemostatic intervention suggested; take measures to eliminate the direct oral anticoagulants (DOACs)
No recommendations can be given for recombinant activated factor VII as a nonspecific haemostatic agent
Original publication
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