With warfarin, the gradual diminishing effect on coagulation is dependent on hepatic function. 1 Anticoagulant interruption may suffice if reversal is desired in a few days to within a week. In nonurgent cases, including planned procedures, reversal of anticoagulant agents can be achieved by withholding the medication. 1 As novel oral anticoagulants (NOACs) become increasingly popular, pharmacists should be cognizant of both monitoring and reversal strategies for them, which primarily stem from the pharmacokinetic and pharmacodynamic properties of each agent as outlined in TABLE 1. These drugs work by interrupting the coagulation cascade and show similar efficacy to warfarin. 1 Newer agents, such as the direct thrombin inhibitor dabigatran and the factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) have recently been introduced. Warfarin, which inhibits vitamin K epoxide reductase, preventing the formation of vitamin K–dependent clotting factors (II, VII, IX, X), had previously been the only oral anticoagulant available. The widespread use of oral anticoagulants for various conditions has resulted in the necessity to have rapid-acting reversal agents in critical situations such as life-threatening bleeds or urgent surgical procedures. As a result, healthcare providers, principally pharmacists, must be prepared to appropriately monitor and manage patients requiring reversal. While no true antidote is yet available, several promising agents are in development. Unlike warfarin, limited options currently exist for rapid reversal of novel oral anticoagulants (direct thrombin inhibitors, factor Xa inhibitors) and include fresh frozen plasma and prothrombin complex concentrates. Coagulopathy is an inherent risk for all anticoagulants, and data regarding reversal of newer agents are sparse. ABSTRACT: Oral anticoagulants are commonly prescribed for the prevention and treatment of thromboembolic disorders.
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