Background: Direct oral anticoagulants (DOACs) offer consistent and predictable anticoagulation, oral
administration with good patient compliance and a good safety profile. Dabigatran - a direct thrombin inhibitor,
apixaban and rivaroxaban - direct factor Xa inhibitors are now largely used for anticoagulation in patients with nonvalvular
atrial fibrillation and in patients with venous thromboembolism. These agents have emerged as an expediential
clinical choice in long-term anticoagulation for an increasing number of patients. Despite their advantages,
concerns persist about a lack of rapid reversal agents in urgent clinical situations.
Methods: This review is focused on the pharmacology of nonspecific and target-specific reversal agents for
DOACs-induced anticoagulation. A systemic review of preclinical and clinical studies published in peer-reviewed
scientific journals was performed.
Results and Conclusions: Fresh frozen plasma and coagulation factors concentrates might be considered in bleeding
emergencies; however, there is a lack of larger studies confirming the efficacy of coagulation factors concentrates
for the reversal of DOACs-induced anticoagulation, and a particular risk of coagulation factors concentrates-induced
thrombosis. Recently, idarucizumab has been approved commercially for acute reversal of dabigatran in emergencies
as a first target-specific reversal agent. Moreover, andexanet alpha and aripazine are being extensively studied
in several phase II and III clinical studies. It is likely that more target-specific agents for reversal of DOACs-induced
anticoagulation will be introduced to clinical practice in near future.