{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T17:45:54Z","timestamp":1787852754001,"version":"build-2784847793"},"reference-count":125,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T00:00:00Z","timestamp":1731542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AstraZeneca"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Direct oral anticoagulants (DOACs) are increasingly being used due to their improved efficacy\/safety ratio and lower clinical and economic burden when compared to vitamin K antagonists. However, bleeding is still the most frequent complication associated with DOACs, and although rare, bleeding episodes can be life-threatening or critical. The impact of DOAC anticoagulation activity during a bleeding event must be evaluated according to patient clinical assessment, dosage and time from last intake, the presence of comorbidities (especially kidney and liver dysfunction), and, whenever possible, coagulation tests. Unfortunately, DOACs\u2019 anticoagulation activity is not easily or usually detectable in routine common coagulation testing. Specific DOAC tests allow for specific drug monitoring, but they are too time consuming, and are usually unavailable in routine emergency practice. If a clinically relevant DOAC plasma concentration is assumed or proven in a severe bleeding scenario, DOAC reversal is needed to restore hemostasis. This experts\u2019 consensus provides a narrative review about DOAC reversal and practical life-threatening bleeding management in several scenarios (trauma, intracranial hemorrhage and gastrointestinal bleeding), focusing on the selection of patients to whom specific reversal agents should be given.<\/jats:p>","DOI":"10.3390\/jcm13226842","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T09:14:31Z","timestamp":1731575671000},"page":"6842","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Urgent Reversal of Direct Oral Anticoagulants in Critical and Life-Threatening Bleeding: A Multidisciplinary Expert Consensus"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9981-030X","authenticated-orcid":false,"given":"Anabela","family":"Rodrigues","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Imuno-Hemoterapia, Unidade Local de Sa\u00fade (ULS) Santa Maria, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana Ricca","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Imuno-Hemoterapia, Unidade Local de Sa\u00fade (ULS) S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0131-9430","authenticated-orcid":false,"given":"Tiago","family":"Greg\u00f3rio","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Medicina Interna e Unidade AVC, Unidade Local de Gaia e Espinho, 4434-502 Vila Nova de Gaia, Portugal"},{"name":"CINTESIS\u2014Centro de Investiga\u00e7\u00e3o em Tecnologias e Servi\u00e7os de Sa\u00fade, 4200-450 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cil\u00e9nia","family":"Baldaia","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Medicina Intensiva, Unidade Local de Sa\u00fade (ULS) Santa Maria, 1649-028 Lisboa, Portugal"},{"name":"Servi\u00e7o de Gastroenterologia, Unidade Local de Sa\u00fade (ULS) Santa Maria, 1649-028 Lisboa, Portugal"},{"name":"Cl\u00ednica Universit\u00e1ria de Gastrenterologia, Faculdade de Medicina de Lisboa, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo C.","family":"Santo","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Neurologia, Hospitais da Universidade de Coimbra, Unidade Local de Sa\u00fade (ULS) de Coimbra, 3004-561 Coimbra, Portugal"},{"name":"Center for Innovative Biomedicine and Biotechnology (CiBB), Universidade de Coimbra, 3004-561 Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Gouveia","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Medicina Intensiva, Unidade Local de Sa\u00fade (ULS) Santa Maria, 1649-028 Lisboa, Portugal"},{"name":"Cl\u00ednica Universit\u00e1ria de Medicina Intensiva, Faculdade de Medicina de Lisboa, 1649-028 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Aldhaeefi, M., Badreldin, H.A., Alsuwayyid, F., Alqahtani, T., Alshaya, O., Al Yami, M.S., Bin Saleh, K., Al Harbi, S.A., and Alshaya, A.I. 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