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CME: Reversal of Novel Oral Anticoagulants (NOACs)


Activity 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.

This program is supported by an educational grant from Portola Pharmaceuticals

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

Faculty: Diane Birnbaumer, MD


Learning 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



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


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

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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