Clinical review: Clinical management of new oral anticoagulants: a structured review with emphasis on the reversal of bleeding complications

Table 4 Pro-hemostatic agents and their potential role on the reversal of new oral anticoagulants

Agent	Doses tested in human studies	Dabigatran etexilate	Rivaroxaban or Apixabana
Four-factor prothrombinase complex concentrate (Beriplex, Octaplex)	12.5 to 100 IU/kg	Possibly beneficial	Probably beneficial
	50 IU/kg is the only dose tested in vivo in humans
Activated four-factor prothrombinase complex concentrate (FEIBA)	20 to 160 IU/kg	Probably beneficial	Probably beneficial
Recombinant activated factor VII (Novoseven, Niastase)	20 to 500 μg/kg)	Possibly beneficial	Possibly beneficial
Fresh frozen plasma	Not applicable	Probably ineffective	Probably ineffective
Cryoprecipitate	Not applicable	Probably ineffective	Probably ineffective
Three-factor prothrombinase complex concentrate	No data available	No available evidence	No available evidence
Antifibrinolytic agents (Aminocaproic acid-Amicar; Tranexamic acid-Cyklokapron)^b	No data available	No available evidence	No available evidence

No study has assessed the clinical effect of these agents in patients with active bleeding events. The possible role of these agents is based on animal studies and human studies evaluating surrogate coagulation markers. All evidence should be considered low quality and the use of these agents should follow a careful consideration of risks and benefits. ^aNo study has assessed the clinical effect of these agents in patients receiving apixaban. The possible role of these agents is theoretical and is based on extrapolation of evidence available for patients receiving rivaroxaban. ^bThere is no available evidence regarding efficacy or safety. Adapted from [23, 26, 29, 30, 33, 39, 41, 43, 46].

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