A UK-wide analysis of 2265 patients receiving a reversal agent for direct oral anticoagulant–associated bleeding
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Reversal agents are used in patients taking direct oral anticoagulants (DOACs) to manage bleeding, but evidence for their effectiveness remains limited. OBJECTIVES: This study assessed the proportion of patients treated with a reversal agent for DOAC-associated bleeding who had major bleeding and evaluated their outcomes. METHODS: This was a retrospective, observational audit across 65 hospitals in the United Kingdom. Adults who received andexanet alfa, idarucizumab, or 4-factor prothrombin complex concentrate (4F-PCC) for DOAC-associated bleeding between October 2020 and June 2023 were included. Data were collected on demographics, medical history, bleed site and severity, reversal agent, thrombosis, and 90-day mortality. A propensity score-matched analysis was performed to estimate the cumulative incidence of thrombosis and death according to reversal agent in gastrointestinal hemorrhage. RESULTS: Of 2265 patients, 875 (38.6%) had gastrointestinal bleeding and 1012 (44.7%) had intracranial hemorrhage. Median age was 81 years. Median time from bleed onset to reversal was 6.5 hours, and that from last anticoagulant dose was 16.0 hours. Of 1253 patients with nonintracranial bleeds, 1001 (79.9%) had major hemorrhage. In a propensity score-matched analysis of 494 patients with gastrointestinal bleeding, there was no significant difference in 90-day-mortality with andexanet alfa compared with that with 4F-PCC (36.4% vs 32.4%), but andexanet alfa was associated with a significantly increased 30-day incidence of stroke (4.5% vs 0%). CONCLUSION: Reversal agents were generally used in patients with clinical evidence of major bleeding but were administered long after the last anticoagulant dose. In gastrointestinal bleeding, andexanet alfa was associated with a higher thrombotic risk than 4F-PCC.
Authors: Richard J. Buka, Michala Pettitt, Jasmine Makker, David J. Sutton, Bryar Kaddir, Andrew Doyle, Gillian Lowe, Rita Perry, Valerie Abbey, Alameldin Abdallah, Mohanad 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, Peter Baker, Sneha Balakrishnan, Mahina Baloch, Anjuli Banerjee, Gaynor Barrett, Giorgio Bartalucci, John Bartoli-Abdou, Ankhi Barua, Alexander Bashford, Karthik Basker, Gilda 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, Sedeshka Cakmak, Ipek Cakmak, Ross Campbell, Samantha Carrington, Matthew Carter, Daniel Castle, Dominique Chan-Lam, Shikha 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, Suzanne 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, Charlotte 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, Sungjoo 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, Trusha Kolke, Neena Krishnan, Ayodeji Kunlere, Arka Kyaw, Grace Langford, Alex Langridge, Shafaq Lashari, Declan 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 D. 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 Y. 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, Zin Oo, Min Zin Oo, Dina Osman, Doha Osman, Hajer Oun, Oluwatamilore Oyewunmi, Andrew Page, Charles Page, Krushika Paleja, Athanasia Sinti 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, Benjamin Recaldin, Udaya Reddy, Wynona Reed, Hannah Reeves, James Riley, Ali Rismani, Jane Ritchie, Kristine 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, Surenthini Salmon, Fady Samy, Rebecca Sarsam, Hayley 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 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, Jane Wylie, Rehab Yassin, Dogan Yildiz, Idrees Zafar, Than Zaw, Mairi Walker, Laura Magill, Raza Alikhan, Phillip LR. Nicolson
Institution: University of Birmingham
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,750
OpenAlex ID: W4416958220