J Emerg Med. 2025 Jun 4;75:24-46. doi: 10.1016/j.jemermed.2025.05.013. Online ahead of print.
ABSTRACT
BACKGROUND: Direct oral anticoagulants (DOAC) have emerged as an alternative to warfarin for treating venous thromboembolism and stroke prevention in atrial fibrillation. Reversal agents such as idarucizumab and andexanet alfa are not widely and readily available in Malaysia. In their absence, international guidelines recommend the administration of prothrombin complex concentrates (PCC) in life-threatening bleeding caused by DOAC.
OBJECTIVE: To describe the reported PCC effectiveness and safety in reversing the anticoagulant effects of DOAC and provide better insight into its current practice in Malaysia.
METHODS: This scoping review was conducted using the following databases: PubMed, Wiley Online Library, Sage Journals, and Google Scholar from 2016 until 2020. Clinical studies focusing on the utilization of PCC in the reversal of DOAC and fulfills the PRISMA extension for Scoping Reviews checklist were included. This review was registered with the National Medical Research Register, Malaysia (NMRR ID-22-01355-DC3).
RESULTS: The systematic search retrieved 599 studies, 20 of which met the inclusion criteria. All studies described the use of PCC as a reversal agent for DOAC, with doses ranging between 25 and 50 u/kg. Hemostatic effectiveness was reported in 15 studies, 12 of which used the International Society on Thrombosis and Haemostasis (ISTH) criteria. All 20 studies assessed the safety of PCC in terms of overall risk of thrombotic events and mortality.
CONCLUSIONS: Further high-quality studies are essential to deepen understanding regarding PCC effectiveness and safety in achieving clinical hemostasis. However, this review provides the information regarding PCC as an option when DOAC-specific reversal agents are unavailable, or the type of DOAC is unknown.
PMID:40614463 | DOI:10.1016/j.jemermed.2025.05.013