Over the past several years a new era for patients requiring anticoagulation has arrived. The approval of new target specific oral
anticoagulants offers practitioners several advantages over traditionally used
vitamin K antagonist agents including predictable pharmacokinetics, rapid onset of action, comparable efficacy and safety, all without the need for routine monitoring. Despite these benefits, hemorrhagic complicates are inevitable with any anticoagulation treatment. One of the major disadvantages of the new oral
anticoagulants is lack of specific antidotes or reversal agents for patients with serious
bleeding or need for urgent surgery. As use of the new target specific oral
anticoagulants continues to increase, practitioners will need to understand both the pharmacodynamics and pharmacokinetic properties of the agents, as well as, the available literature with use of non-specific
therapies to reverse anticoagulation. Four factor
prothrombin complex concentrates have been available for several years in Europe, and recently became available in the United States with approval of Kcentra. These products have shown efficacy in reversing anticoagulation from
vitamin K antagonists, however their usefulness with the new target specific oral
anticoagulants is poorly understood. This article will review the properties of
dabigatran,
rivaroxaban and
apixaban, as well as the limited literature available on the effectiveness of
prothrombin complex concentrates in reversal of their
anticoagulant effects. Additional studies are needed to more accurately define the role of
prothrombin complex concentrates in patients with life threatening
bleeding or who require emergent surgery, as current data is both limited and conflicting.