Perspectives: Anticoagulation Management

Peter R. Kowey

Peter R. Kowey


  • Professor of Medicine and Clinical Pharmacology
  • Jefferson Medical College
  • Chief, Division of Cardiovascular Diseases
  • Main Line Health System
  • The William Wikoff Smith Chair in Cardiovascular Research
  • Lankenau Hospital and Medical Research Center
  • Wynnewood, Pennsylvania

Anticoagulation reversal in emergency situations

It is important to note that there are no reversal agents currently available for novel oral anticoagulants (NOACs). Therefore, clinicians who are confronted with patients who are having severe bleeding will inevitably resort to interventions they have used before that might be helpful. However, in this situation they may not be helpful. For example, fresh frozen plasma or concentrates of clotting factors are used, but none of these interventions have been systematically investigated in patients who are in the middle of having a bleeding problem. There is ongoing research to try to identify a reversing agent for these compounds.

It is important to note that NOACs are eliminated reasonably quickly, with half-lives ranging from 5 to 17 hours in the presence of normal renal function. Therefore, there is limited duration until the anticoagulant effects resolve. One NOAC may be removed by hemodialysis, which may help to decrease serum concentrations, and therefore anticoagulant effects, more rapidly. But we really don’t have a systematic answer to the question. And so when the bleeding episodes are serious, the focus is on trying to facilitate the elimination of the drug, and get to the site of the bleeding as quickly as possible. I think what’s really interesting about NOACs is that these drugs are challenging physicians to understand pharmacology in a way that they’ve not really been challenged before. They really need to know a lot more about how drugs are handled in order to be able to use them optimally, and also to reverse complications.

About the Coagulation Center

The Coagulation Center is an educational resource for healthcare professionals. Guided by a global editorial board of experts, the Coagulation Center offers a range of clinical perspectives on balancing the benefit and risk of anticoagulation in a rapidly changing landscape. Within the Coagulation Center you will find roundtable discussions on anticoagulation management, materials for patient management including patient case studies, tools to help evaluate bleeding risk and stroke risk, and downloadable resources for your practice.