Direct oral anticoagulants and reversal agents in clinical practice: insights into DOAC discontinuation, minor bleeds, thromboembolic events and protocolized use of reversal agents

We observed that the discontinuation rates varied significantly among the different DOACs. Compared to apixaban, the use of dabigatran and rivaroxaban was associated with a higher risk of discontinuation. Our data showed that minor bleeding was common in users of DOACs, especially with apixaban and rivaroxaban. Our study found that the average cost of minor bleeding exceeded those reported in the literature. We found that in DOAC users, the levels of trust, annoyance, and concern were not significantly affected by minor bleeding or adherence to treatment and impacted daily life and physical activities. However, we observed large inter-individual differences, with some patients reporting a high impact of minor bleeding. Our findings indicate a stronger association between rivaroxaban therapy and VTE than with other DOACs. The protocols for management of DOAC -related bleeding and perioperative DOAC use vary in content and often do not include information. We found moderate to complete adherence to the bleeding protocol for PCC, idarucizumab, and andexanet alfa, respectively. The adherence to urgent protocols was low for PCC, idarucizumab, and andexanet alfa, respectively.