{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:28:10Z","timestamp":1789446490545,"version":"build-2803163510"},"reference-count":103,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In clinical practice, the number of patients treated with direct oral anticoagulants (DOACs) has consistently increased over the years. Since anticoagulant therapy has been associated with an annual incidence of major bleeding (MB) events of approximately 2% to 3.5%, it is of paramount importance to understand how to manage anticoagulated patients with major or life-threatening bleeding. A considerable number of these patients\u2019 conditions necessitate hospitalization, and the administration of reversal agents may be imperative to manage and control bleeding episodes effectively. Importantly, effective strategies for reversing the anticoagulant effects of DOACs have been well recognized. Specifically, idarucizumab has obtained regulatory approval for the reversal of dabigatran, and andexanet alfa has recently been approved for reversing the effects of apixaban or rivaroxaban in patients experiencing life-threatening or uncontrolled bleeding events. Moreover, continuous endeavors are being made to develop supplementary reversal agents. In emergency scenarios where specific reversal agents might not be accessible, non-specific hemostatic agents such as prothrombin complex concentrate can be utilized to neutralize the anticoagulant effects of DOACs. However, it is paramount to emphasize that specific reversal agents, characterized by their efficacy and safety, should be the preferred choice when suitable. Moreover, it is worth noting that adherence to the guidelines for the reversal agents is poor, and there is a notable gap between international recommendations and actual clinical practices in this regard. This narrative review aims to provide physicians with a practical approach to managing specific reversal agents.<\/jats:p>","DOI":"10.3390\/jcm13092451","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T03:20:41Z","timestamp":1713842441000},"page":"2451","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Coagulation Tests and Reversal Agents in Patients Treated with Oral Anticoagulants: The Challenging Scenarios of Life-Threatening Bleeding and Unplanned Invasive Procedures"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9819-2148","authenticated-orcid":false,"given":"Andrea","family":"Pozzi","sequence":"first","affiliation":[{"name":"Cardiology Division Valduce Hospital, 22100 Como, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5369-5382","authenticated-orcid":false,"given":"Fabiana","family":"Luc\u00e0","sequence":"additional","affiliation":[{"name":"Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7746-989X","authenticated-orcid":false,"given":"Sandro","family":"Gelsomino","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Maastricht University Hospital, 6229 HX Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0237-7157","authenticated-orcid":false,"given":"Maurizio Giuseppe","family":"Abrignani","sequence":"additional","affiliation":[{"name":"Operative Unit of Cardiology, P. Borsellino Hospital, 91025 Marsala, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Giubilato","sequence":"additional","affiliation":[{"name":"Cardiology Department, Cannizzaro Hospital, 95126 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8586-9930","authenticated-orcid":false,"given":"Stefania Angela","family":"Di Fusco","sequence":"additional","affiliation":[{"name":"Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo Massimiliano","family":"Rao","sequence":"additional","affiliation":[{"name":"Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4311-2139","authenticated-orcid":false,"given":"Stefano","family":"Cornara","sequence":"additional","affiliation":[{"name":"Arrhytmia Unit, Division of Cardiology, Ospedale San Paolo, Azienda Sanitaria Locale 2, 17100 Savona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Caretta","sequence":"additional","affiliation":[{"name":"Sant\u2019Andrea Hospital, ASL 5 Regione Liguria, 19124 La Spezia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Ceravolo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Giovanni Paolo II Hospital, 97100 Lamezia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0038-9445","authenticated-orcid":false,"given":"Iris","family":"Parrini","sequence":"additional","affiliation":[{"name":"Cardiology Department, Mauriziano Hospital, 10128 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0092-8717","authenticated-orcid":false,"given":"Giovanna","family":"Geraci","sequence":"additional","affiliation":[{"name":"Cardiology Unit, S. Antonio Abate Hospital, ASP Trapani, 91016 Erice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Riccio","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, Sant\u2019Anna e San Sebastiano Hospital, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9347-8884","authenticated-orcid":false,"given":"Massimo","family":"Grimaldi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, General Regional Hospital \u201cF. Miulli\u201d, 70021 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7187-2234","authenticated-orcid":false,"given":"Furio","family":"Colivicchi","sequence":"additional","affiliation":[{"name":"Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Oliva","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele Massimo","family":"Gulizia","sequence":"additional","affiliation":[{"name":"Cardiology Department, Garibaldi Nesima Hospital, 95122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Morgan, A., Joshy, G., Schaffer, A., Laba, T.-L., Litchfield, M., Pearson, S., and Banks, E. 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