5/26/2023 0 Comments Idarucizumab reversal![]() 1-4 In patients presenting within two to six hours of a suspected overdose with either dabigatran or apixaban, the use of activated charcoal has been investigated as a reasonable measure. ![]() Volume resuscitation and local hemostatic measures can be employed in such situations given the relatively short half-lives of these drugs, especially in patients with normal renal function. Regardless of the NOAC administered, supportive measures remain first line in treating patients with bleeding complications, suspected over-anticoagulation, or in need of procedures (time and clinical stability permitting). However, given the lack of clinical experience with these novel antidotes, their efficacy and safety profile in clinical practice remains to be seen. ![]() The management of such bleeding episodes is likely to evolve in light of the recent accelerated approval by the US Food and Drug Administration (FDA) of idarucizumab, with several other targeted antidotes currently in development. This challenge is compounded by a lack of reliable and readily available laboratory means of monitoring the anticoagulant effect of NOACs. As the utilization of non-vitamin K oral anticoagulants (NOACs) increases among patients with non-valvular atrial fibrillation, the management of bleeding episodes and emergent periprocedural risk reduction remains an important clinical challenge.
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