![]() 2, 3 Both dabigatran and rivaroxaban are associated with a lower risk of intracranial hemorrhage, but a higher risk of gastrointestinal bleeding compared with warfarin. The incidence of major bleeding was similar for dabigatran and warfarin (3.11% on 150 mg twice daily vs 3.36%) and for rivaroxaban and warfarin (3.6% vs 3.4%). 3 As with warfarin, bleeding is the most feared complication among patients on novel anticoagulants. 2 The ROCKET trial demonstrated non-inferiority of rivaroxaban compared with warfarin in preventing stroke and systemic embolism (2.1% vs. The RE-LY trial demonstrated superior efficacy of dabigatran at a dose of 150 mg twice a day compared with warfarin (1.11% per year vs. Two pivotal trials, RE-LY 2 (dabigatran) and ROCKET 3 (rivaroxaban), established the efficacy of the new agents for stroke and systemic embolism prevention in AF. Rivaroxaban also has additional indications for treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE). Both of these new agents are indicated for stroke and systemic embolism prophylaxis in patients with nonvalvular atrial fibrillation (AF). 1 However, the FDA approval of new anticoagulants dabigatran (October 2010) and rivaroxaban (November 2011) are changing the landscape of oral anticoagulant therapy. Seventy years since its discovery and 59 since its commercial introduction in 1954, warfarin remains the most widely used oral anticoagulant. Determining patient-specific factors that influence the effectiveness of reversal treatments and comparing the effectiveness of various treatment strategies are pertinent areas for future anticoagulation reversal research. Given the increasing use of the newer agents, focused research is needed to identify effective reversal strategies and develop and implement an accurate method (assay) to guide reversal of the newer agents. ![]() While reliable recommendations are available for anticoagulation reversal in patients treated with warfarin, guidance on reversal of dabigatran and rivaroxaban is varied and equivocal. We highlight the literature that shaped these recommendations and provide directions for future research to address knowledge gaps. This review discusses current anticoagulation reversal recommendations for the oral anticoagulants warfarin, dabigatran, and rivaroxaban for patients at a heightened risk of bleeding, actively bleeding or those in need for pre-procedural anticoagulation reversal. Therefore, we performed a systematic search of the PubMed database to find studies and reviews pertaining to oral anticoagulation reversal strategies. The lack of reliable monitoring methods and specific reversal agents renders treatment strategies empirical and as a result,, treatment consists mainly of supportive measures. Although the use of dabigatran and rivaroxaban are increasing, data on reversal of their effects are limited.
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