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CME: Reversal of Novel Oral Anticoagulants (NOACs)


Program Description / Statement of Need:

Anticoagulants often represent a cornerstone of therapy for patients at high risk of thrombosis. Approximately 4 million patients in the United States receive anticoagulants as primary or secondary thromboprophylaxis, a number that is expected to increase over one and a half times as guidelines shift to include more patients and indications.


Because all anticoagulants inhibit one or more clotting cofactors, unanticipated bleeding is a serious concern. Vitamin K antagonists (VKAs) may be quickly reversed with an intravenous injection of vitamin K. Until recently, the lack of a reversal agent was one of the most commonly cited disadvantages of NOACs, and was likely factor slowing their adoption into newer therapy. Fortunately, several reversal agents are in development, and one has reached the market. For those NOACs that do not yet have approved antidotes, nonpharmacologic reversal techniques do exist, and supportive care becomes a priority.




Introduction to NOACs [Objective 1]

  • Indications for anticoagulation
  • NOACs
  • Pharmacokinetics
    • Half-life & excretion compared with VKAs
    • Drug interactions
    • Bleeding events

Anticoagulant reversal [Objectives 2 & 3]

  • Indications for reversal
    • Urgent versus emergency
    • Risks for “rebound”
    • The impact of renal function
    • Monitoring coagulation state
      • Creatinine clearance
      • Drug-specific assays
      • Last intake of NOAC

New and emerging anticoagulant reversal agents [Objectives 3 & 4]

  • Mechanisms of action
    • Monoclonal antibodies
    • Antagonistic binding
    • Prothrombin complex concentrate
    • Class-specific versus drug-specific antidotes
    • Affinity & half-life
    • Anticoagulation recurrence following reversal
    • Relevant clinical trials
      • Safety and efficacy
      • Time to hemostasis
      • Quality of evidence & inclusion of life-threating bleeds
      • Patient case(s)

Summary, best practice recap, conclusion


Target Audience:

The following healthcare professionals: cardiologists, trauma surgeons, emergency medicine specialists, intensivists, internists; physician assistants, nurse practitioners, nurses, and pharmacists who practice in anticoagulation, emergency medicine, or critical care; and any other healthcare professionals who clinically encounter patients taking NOACs.

Program Objectives:

By the end of the session the participant will be able to:

    • Describe the pharmacodynamics and pharmacokinetics of novel oral anticoagulants (NOACs) with a focus on aspects that impact the reversibility of the drugs
    • Identify the indications for administration of NOAC antidotes or reversal agents, and describe situations in which laboratory testing for coagulation is appropriate
    • Apply NOAC reversal agents to patient cases taking the patient history and clinical presentation into account
    • Describe the mechanisms of action of novel oral anticoagulants and their reversal agents, including universal and class- or drug-specific reversal agents


    This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.


    Credit Designation: ScientiaCME designates this educational activity for a maximum of  1 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.




    ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmaceutical education. This program is approved for 1.0 hours (0.1 CEUs) of continuing education.  Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test.   Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit.  ACPE # 0574-0000-17-045-H01-P.  ACPE Accreditation effective 10/15/17, expires 10/15/19. 

    This is a Knowledge (K)-type activity.

    Release Date: October 15, 2017
    Expiration Date: October 15, 2019

    Faculty: Diane Birnbaumer MD

    Faculty Disclosure and Resolution of COI:

     As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.


    Faculty Disclosure:   Diane Birnbaumer, MD, FACEP, Emeritus Professor of Medicine University of California, Los Angeles, Senior Clinical Educator Department of Emergency Medicine Harbor-UCLA Medical Center has served as a consultant to Securisyn.


    Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP has no relevant conflicts of interest to disclose.


    Commercial Support Disclosure: This program is supported by an educational grant from Portola Pharmaceuticals

    Additional Courses That Are Related To This Course

    Dyslipidemia and atherosclerotic cardiovascular disease (ASCVD): Updates from American Heart Association Scientific Session (AHA) 2016


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    -Read the learning objectives and faculty disclosures above

    -Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.

    -View the on-line program. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.

    -Take the post-test

    -Complete the program evaluation and CME registration. A CE certificate will be emailed to you.

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    Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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    Complete the Symposium Evaluation and Request CE Certificate

This program is supported by an educational grant from Portola Pharmaceuticals


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