Accès ouvert déclaré
2026
article
A UK-wide analysis of the use of reversal agents in 198 patients on direct oral anticoagulants prior to urgent procedures
Molly Murphy, Michala Pettitt, Jasmine Makker, David J. Sutton, Bryar Kaddir, Andrew Doyle, Gillian Lowe, Rita Perry, Valerie Abbey, Alameldin Abdallah, MAohanad Abdelrahim, Ahmed Aboelmaaty, Ritika Abrol, Mutiu Adeyemo, Yasmin Ahmadi, Reem Ahmed, Maheen Ahsan, Laura Aiken, Lakhan Ajmeria, Asfana Akhi, Arun Alfred, Yasir Alhamdi, Adam Ali, Aamir Ali, Ariba Ali, Sahla Ali, Hazem Alnatour, Julia Anderson, Claire Anderson, Syed Abid Anjum, Laura Anthony, Saira Anwar, Muzna Aquil, Spatika Ashwini, Luke Attwell, Tin Aung, Thatoe Aung, Nazish Aurangzeb, Dr Peter Baker, Sneha Balakrishnan, Mahina Baloch, Anjuli Banerjee, Gaynor Barrett, Giorgio Bartalucci, John Bartoli-Abdou, Ankhi Barua, Alexander Bashford, Karthik Basker, G. Bass, Jireh Ann Batac, Laura Batey, Chithrangani Batugedara, Ala Bawazir, Sue Beach, Lauren Beattie, Holly Beckett, Edward Belsham, Edward Benn, Gary Benson, Caroline Betts, Gopika Bhaskar, Sonal Bhatte, Rachael Biggart, Nuno Borges, Aparna Bose, Sara Boyce, Kubra Boza, Olivia Brooke, Stanley Broughton, Clare Brown, Emily Buchanan, Michael Buckton, Tom Bull, Carol Buttriss, Lorna Cain, S. Cakmak, Ipek Cakmak, Ross Campbell, Samantha Carrington, Matthew Carter, Daniel Castle, D. Chan‐Lam, Sanjay Chattree, Jia Ning Chen, Sue Lyn Chia, Shyamala Chinnabhandara, Catherine Chinnery, Tatiana Christmas, Deborah Clark, Charlotte Claydon, Ayodeji Coker, Freya Collings, Amy Cooper, Zignat Courtoux, Joanne Craig, Filippo Croce, Francesca Crolla, Henry Crosland, Kirsty Crozier, Ruth Cumber, Nicola Curry, Annie Curtis, Amapreet Davi, Olga Delacruz, Alison Delaney, Nicholas Denny, Ian Devanny, Prathiksha Dhanaraj, Saniya Dhawan, Jake Diack, Tsvetina Dimitrova, S. Docherty, Maribeth Donaldson, Francesca Doughty, Samantha Drummond, Christie Drury, Madeleine Durkan, Portia Eardley, Timothy Ebsworth, Dewi Eden, Hugh Edwards, Katherine Elgar, Mohamed Elhadi, Lauren Ellis, Shereef Elmoamly, Astrid Etherington, Sally Evans, Edward Evans, Sophie Evans, Angharad Everden, Thomas Fail, Dina Fathoala, Joanna Fawcett, Cliona Flanaghan, Robbie Forsythe, Benjamin Franci, Rhian Fuge, Agata Gaertner, Sana Galfour, Julian Gertner, Milad Ghanikolahloo, Hannah Giles, Girgis Girgis, Poppy Godding, Shreya Goel, Tennelle Goulbourne, Benjamin Gray, Shane Grealish, Victoria Greer, Sharran Grey, Jessica Griffin, Sudarshan Gurung, La’ali Gutierrez, Cecilia Gyansah, Thura Htut, Anthony Hackett, Thwe Han, Elizabeth Hardiman, Laya Hariharan, Noor Haris, Emma Harris, Michelle Harrison, Alistair Hart, Nayeem Hasan, Aidan Haslam, Eman Hassan, Joanna Haughton, Myo Hein, Joannes Hermans, Carol A. Hickman, Joshua Hinds, Kelly Holton, Luke Hone, David Hopkins, Joanne Hoyle, Myint Htwe, Nathan Hutchinson-Jones, Kaustubh Ieetkar, Jack Illingworth, Mishal Iqbal, Hussein Jabbar, Nkemdirim Jacob, Laura James, Fatima Jamil, Nadeera Jayasekara, Sheila Jen, Scott Jenkins, Michael Joffe, Erith Jones, Elizabeth Jones, Benedict Jong, Emma Jongman, S. W. Kang, Angela Kanny, Mamatha Karanth, Farheen Karim, Richard Karim, Sajida Kazi, Ron Kerr, Rimsha Khan, Mohammed Khan, Jahanzeb Khawaja, Milo Kmonicek, Amy Knott, Laura Knox, Trushka Kolke, Neena Krishnan, Ayodeji Kunlere, Arka Kyaw, Grace Langford, Alex Langridge, Shafaq Lashari, D.K. Leahy, Heather Leary, Claire Lentaigne, Francesca Leonforte, Sarah Lewis, Anand Lokare, Karyn Longmuir, Cheryl Ludlam, Apurva Lunia, Pyae Lwin, Ibrahim Maab, Ben MacLeod, Rhona MacLean, Catriona Mactier, Gihan Mahmoud, Tara Maisel, Herng Mak, Aritri Mandal, Stuart Mann, Zoha Mansoor, Claire Mapplebeck, Elizabeth Marrinan, Brigitta Marson, Natalie Martin, Navta Masand, Jon Massie, Abhinav Mathur, Bernard Maybury, Thomas Mayo, Michael McDonald, Ella McDuffus, Graham McIlroy, Anke Meess, Michelle Melly, Kainat Memon, Jerssy Mhike, Loredana Gabriela Mihailescu, Jayna Mistry, Amany Mohamed, Sarah Mohamed, Elnour Mohamed, Khatib Mohammad, Thet Mon, Shivir Moosai, Samuel Morfett, James Morgan, Kerry Morrison, Kat Moss, Omar Mukhlif, Saman Mukhtar, Christopher Mullen, Laura Munglani, Jack Murrell, Komal Naeem, Taran Nandra, Stephanie Narine, Georgina Naylor, Lorna Neill, Loretta Ngu, Faiza Noor, Bright Nwatamole, Oluwasijibomi Olusola, Fatima Omrani, Nwe Oo, Dr Zin Oo, Min Zin Oo, Dina Osman, Doha Osman, Hajer Oun, Oluwatamilore Oyewunmi, Andrew Page, Charles Page, Krushika Paleja, Antonia Papadaki, Katrina Parsons, Fahan Patel, Aran Patel, Satya Lohitha Pedapati, Xavier Peer, Sam Pell, Kumari Perera, Joshua Peterson, James Phillips, Miriam Botelho Duarte Portela McKean, Matthew Powell, Mary Preston, Clare Proudfoot, Indu Punchihewa, Jackie Quinn, Maya Raj, Florije Raka, Chavin Ranasinghe, B. Recaldin, Udaya Reddy, Wynona Reed, H.A. Reeves, James Riley, Ali Rismani, Jane Ritchie, K De Rivera, Lara Roberts, Patrick Roberts, Emily Robinson, Lisa Robinson, Philip Robson, Ryan Rodgers, Daniel W. Rogalsky, Victoria Rowson, Jackie Ruell, Jane Rutherford, Walaa Saad, Kamran Sabir, Malahat Saeed, Zahbia Saleem, S. E. Salmon, Fady Samy, Rebecca Sarsam, H. William Scott, Tom Scrivin, Moncef Seddiki, Sidhant Seth, Jainam Shah, Fatima Shakkak, Rebecca Shaw, Sam Sherratt-Mayhew, Amrit Shetty, Anjali Shrestha, Julia Sillito, David Simcox, Thomas Skinner, Sophie Smith, Shalini Solanki, David Sparksman, Vimal Stanley, Elizabeth Steven, Phillippa Stimpson, Maryam Subhan, Kajani Subhaskaran, Nadia Mohamed Taha, Fatimah Talha, Balsam Tameemi, Juan Tan, Myuri Thanabalasingam, Alekh Thapa, Angela Theodoulou, Sarah Thislie, Kirstie Thorneycroft, Molly Thorpe, Ellen Tiffin, Sophie Todd, Nuthan Tom, Melissa Truman, Nomathamsanqa Tshuma, Olga Tsiamita, Micky Tsui, Mevish Ul-haq, Nataliia Vilinska, Hrushikesh Vyas, David Waddell, Rachel Walker, Sai Lon Wann, Vicki Ware, Alexander Wathen, Lucy Watkins, George Watkinson, Carys Watson, Simon Watt, Amy Webster, Katie White, Richard Whitmill, Charlotte Wild, Chloe Wilkinson, Gwennan Williams, Emma Williams, Julia Wolf, Hui Wong, Eleanor Wong, Stella Woodward, Rachel Wright, Philip Wright, J. Wylie, Rehab Yassin, Dogan Yildiz, Idrees Zafar, Than Zaw, Mairi Walker, Laura Magill, Raza Alikhan, Phillip L.R. Nicolson, Richard J. Buka
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Résumé fourni par la source
Background: Direct oral anticoagulants (DOACs) are widely prescribed but present challenges when patients require urgent invasive procedures. While idarucizumab is licensed for preprocedural reversal of dabigatran, 4-factor prothrombin complex concentrates (4F-PCCs) are often used off-label for oral factor (F)Xa inhibitors. Objectives: We aimed to describe real-world UK use of reversal agents prior to urgent procedures. Methods: We conducted a UK-wide audit of adults receiving andexanet alfa, idarucizumab, or 4F-PCC to reverse apixaban, dabigatran, edoxaban, or rivaroxaban, before urgent procedures between October 2020 and June 2023. Data were collected by members of HaemSTAR, a UK-wide network led by hematology resident doctors. Primary outcomes were (1) receipt of reversal ≤24 hours before procedure and (2) adherence to recommended dosing. Secondary outcomes included procedural bleeding risk, 90-day mortality, and 30-day thrombosis rate. Results: Data were collected on 198 patients, with 48% undergoing high-risk procedures. Median time from reversal to procedure was 1.6 hours and 76% took place within 24 hours. 4F-PCC was used in 87%, idarucizumab in 8%, and andexanet alfa in 5%. Tranexamic acid was administered in 20%, 90-day mortality was 24%, and thromboembolic events occurred in 3%, all following 4F-PCC. Conclusion: Reversal agents are frequently used prior to urgent procedures in direct oral anticoagulant-treated patients, including for low-risk interventions. There is limited evidence to support the off-label use of 4F-PCC; the risks, benefits, and cost effectiveness are uncertain. Delays to intervention, low use of tranexamic acid, and infrequent drug-level testing highlight opportunities to improve clinical workflows and inform future trials.
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Contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- A UK-wide analysis of the use of reversal agents in 198 patients on direct oral anticoagulants prior to urgent procedures
- Date Crossref
- 01/05/2026
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude et ne compte pas comme une seconde source scientifique indépendante.
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