Response to Letters Regarding Article, “Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate: A Randomized, Placebo-Controlled, Crossover Study in Healthy Subjects”

Emergency Neurological Life Support: Intracerebral Hemorrhage

“…There is some suggestion that PCCs may have limited effectiveness in reversing the effect of rivaroxaban and apixaban, but not of dabigatran [37]. The use of rFVIIa or FEIBA (factor VIII inhibitor bypassing activity) in ICH patients on dabigatran may have potential [38,39].…”

The periprocedural management of novel oral anticoagulants in patients with nonvalvular atrial fibrillation: Rationale and a summary of the available evidence from phase 3 clinical trials

“…In healthy subjects, administration of 4-factor prothrombin complex concentrate (PCC) was effective in reversing laboratory parameters associated with rivaroxaban (PT) but not with dabigatran (PTT, ecarin clotting time, and dilute thrombin time). 30 Experimental models have also shown some efficacy in reversal or stabilization of bleeding with activated factor VIIa, either alone or in combination with PCC (known as activated PCC); however, clinical data are lacking for all of the aforementioned interventions. 31 In addition, activated charcoal potentially can mitigate drug absorption if administered within a few hours of ingestion.…”

New Oral Anticoagulants: How Do We Use Them Wisely?

“…Multiple clinical case reports and case series have been published. Agents that have been suggested to reverse NOAC-associated hemorrhage include recombinant activated factor VIIa (rFVIIa) and various combinations of activated prothrombin complex concentrate (aPCC) [35][36][37][38]. In a randomized, cross-over study of healthy subjects, PCC reverses the anticoagulant effect of rivaroxaban but not dabigatran [37].…”