|
General Measures
|
Confirm DOAC intake history, the timing of the last dose, check for concomitant medicine, particularly antiplatelet drugs, assess for hemodynamic compromise, check the renal function, and oral activated charcoal (if the last dose within prior two hours) |
|
Minor Bleeding
|
Stop therapy, local hemostatic measures, supportive care, and monitoring |
|
Moderate Bleeding
|
All of the above and fluid resuscitation, blood transfusion, consider fresh frozen plasma transfusion, and consider hemodialysis for dabigatran |
|
Major Bleeding
|
All of the above; consider massive transfusion protocol with packed red blood cells, platelets, fresh frozen plasma, and other procedures/surgeries to achieve hemostasis |
| Specific antidotes |
Dabigatran–Idarazcizumab |
| Xa inhibitors (Apixaban, Rivaroxaban, Edoxaban)–Andexant alfa |
| Non-specific reversal agents: 4 Prothrombin complex concentrates (PCC) [Factors II, VII, IX, and X], Tranexamic acid, epsilon- aminocaproic acid, Desmopressin |
|
Future antidotes
|
FXa(116L) for both factor Xa as well as direct thrombin inhibitors |
| PER977 (Arapazine/Chiraparantag) for factor Xa inhibitors |
