LAUSR

Non–vitamin K antagonist oral anticoagulants (NOACs) have gained popularity as alternatives to warfarin for the prophylaxis of stroke and thromboembolic disease, as well as treatment for thromboembolic disease. This increased use is being driven by the drugs’ benefits, including less frequent monitoring, almost no dietary restrictions, and fewer drug-drug interactions than with warfarin. However, limitations in reversal of NOACs can complicate management in patients who present with major life-threatening bleeding while receiving these drugs. There are 2 broad categories of NOACs: direct thrombin inhibitors and factor Xa inhibitors. Direct thrombin inhibitors, such as dabigatran, prevent the conversion of fibrinogen to fibrin by binding to the active site of thrombin. Factor Xa inhibitors, which include rivaroxaban, apixaban, edoxaban, and betrixaban, bind to free and bound forms of Xa, reducing thrombin production. For NOACs, bleeding is the most significant adverse effect, ranging from minor ecchymosis to life-threatening