Management of Major Bleeding with the Non-Vitamin K Oral Anticoagulants: the Role of Antidotes

  • Antonis S Manolis Athens University School of Medicine, Athens, Greece
  • Helen Melita Onassis Cardiac Surgery Center, Athens, Greece
Keywords: anticoagulation, non-vitamin K anticoagulants, dabigatran, rivaroxaban, apixaban, edoxaban, intracerebral hemorrhage, bleeding, antidotes, idarucizumab, andexanet, aripazine


Over the recent years, new oral anticoagulant agents have been developed and entered the clinical arena, the non-vtamin K or direct oral anticoagulants (NOACs). Although more expensive, these agents have been proven as equivalent or superior to vitamin K antagonists in the treatment of non-valvular atrial fibrillation (AF) and venous thrombo-embolism with a lower incidence of intracerebral hemorrhage. Nevertheless, occurrence of major or life-threatening bleeding events is still quite possible. Thus, there is a major concern regarding the lack of a specific antidote and rapid reversal agent in such disastrous situations. Fortunately, the development of effective specific NOAC antidotes has recently made great advances, which are herein briefly reviewed.

Author Biography

Antonis S Manolis, Athens University School of Medicine, Athens, Greece
Specialty: Cardiology