Reversal agents of non-vitamin K dependent anticoagulants: a rapid review of the changing horizon

The newer non-vitamin K dependent anticoagulants (NOACs) have provided a new tool in the armamentarium of physicians treating nonvalvular atrial fibrillation and thromboembolism. Slowly, but steadily, there has been an increased preference of NOACs over vitamin K antagonists. However, the major limiting factor and the concern that precluded their use was lack of reversal in emergent situations. With the advent of reversal agents such as idarucizumab, andexanet alfa and PER977, this gap is also being filled. This will further increase the spectrum of usage of NOACs. In this review we present the detailed information on the completed trials on the reversal agents, the ongoinng trials, and their site of action. The reversal agent idarucizumab is FDA approved and readily available. The others are in clinical trials and are soon expected to be available in clinical practice.