Rivaroxaban reversal - Revision history

Danbot: Add peer-reviewed reference

2026-03-22T10:16:40Z

Add peer-reviewed reference

← Older revision		Revision as of 10:16, 22 March 2026
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	==Background==		==Background==
	*Millions are prescribed [[rivaroxaban]] (Xarelto) for atrial fibrillation, cardiac stents, stroke prevention, DVT/PE and ACS prophylaxis		*Millions are prescribed [[rivaroxaban]] (Xarelto) for atrial fibrillation, cardiac stents, stroke prevention, DVT/PE and ACS prophylaxis<ref>Connolly SJ, et al. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2019;380(14):1326-1335. PMID 30730782</ref>
	*Benefits: supposedly easier to dose, less monitoring than older anticoagulants		*Benefits: supposedly easier to dose, less monitoring than older anticoagulants
	*Downside: uncertainty regarding best mechanism of reversal in case of catastrophic intracranial or GI bleed		*Downside: uncertainty regarding best mechanism of reversal in case of catastrophic intracranial or GI bleed

ClaireLewis at 00:18, 11 September 2016

2016-09-11T00:18:56Z

← Older revision		Revision as of 00:18, 11 September 2016
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	==Background==		==Background==
	*Millions ~~of people in the United States~~ are ~~on at least one type of anticoagulant medication,~~ for ~~a number of medical conditions including~~ atrial fibrillation, ~~placement of~~ cardiac stents, stroke prevention, ~~deep vein thrombosis~~/~~pulmonary embolism,~~ and ~~prevention of acute coronary syndromes.~~		*Millions are prescribed [[rivaroxaban]] (Xarelto) for atrial fibrillation, cardiac stents, stroke prevention, DVT/PE and ACS prophylaxis
	*~~In the past several years, there have been numerous new anticoagulant medications that have entered the market~~, ~~with claims of easier dosing and need for~~ less monitoring ~~compared to~~ older ~~generation medications.~~		*Benefits: supposedly easier to dose, less monitoring than older anticoagulants
	*~~However, with use of these new medications in increasing numbers by the public, and~~ uncertainty regarding ~~the~~ best ~~mechanisms~~ of reversal~~, this can lead to a difficult situation for the emergency physician when a patient on one~~ of ~~these medications presents with a~~ catastrophic intracranial or ~~gastrointestinal~~ bleed.		*Downside: uncertainty regarding best mechanism of reversal in case of catastrophic intracranial or GI bleed
	*~~Since the~~ introduction of ~~the~~ direct thrombin inhibitor (DTI) dabigatran ~~(Pradaxa)~~ and ~~the~~ Factor Xa inhibitors rivaroxaban ~~(Xarelto)~~ and ~~epixiban (Eliquis), there have been multiple studies that have attempted~~ to determine ~~1) which test(s) could be used to assess whether a patient has~~ supratherapeutic ~~drug~~ levels, and ~~2) the~~ best ~~way to reverse anticoagulation in patients on these medications who have a life-threatening bleed.~~		*Multiple studies done since introduction of direct thrombin inhibitor (DTI) [[dabigatran]] and Factor Xa inhibitors [[rivaroxaban]] and [[apixaban]] to determine testing for supratherapeutic levels and best means of reversal, however no good trials that assessing human subjects who are potentially supratherapeutic and symptomatic
	*However, ~~the available studies are lacking in~~ that ~~none of these studies are~~ assessing human subjects ~~taking these medicaitions~~ who are potentially supratherapeutic and symptomatic.

	==Clinical Features==		==Clinical Features==
Line 10:		Line 9:

	==Differential Diagnosis==		==Differential Diagnosis==
	*~~bleeding~~ secondary to other coagulopathy		*Bleeding secondary to other coagulopathy
	*~~spontaneous~~ bleeding		*Spontaneous bleeding

	==Evaluation==		==Evaluation==
	*~~clinical manifestation of GI bleeding~~		*CBC
	*~~low H&H~~		*aPTT/PT: Factor Xa inhibitors affect PT, however unlike with warfarin, degree of PT elevation not directly correlated to level of anticoagulation
	*non contrast head CT showing ICH		*non contrast head CT showing ICH
	*~~Factor~~ Xa ~~inhibiting agents affect the PT, however the~~ degree ~~of PT elevation does not directly correlate with that produced by warfarin and is not reliable in assessing level~~ of anticoagulation ~~with rivaroxaban or epixaban.~~		*Antifactor Xa assays- measure drug levels but not degree of anticoagulation, need to be calibrated for rivaroxaban not LMWH, and often not available in a timely fashion
	*Antifactor Xa assays can be performed but the test needs to be calibrated ~~specifically for these drugs, rather than using the calibration scale~~ for LMWH, ~~in order for the results to be reliable. However, Antifactor Xa assays measure drug levels~~ and not ~~degree of coagulopathy.~~		*Evaluation of clinical manifestation of bleeding (e.g. head CT, endoscopy)
	*~~One test that has shown promise in determining level~~ of ~~coagulopathy and reversal~~ of ~~coagulopathy with both DTIs and Xa inhibitors is the Calibrated Automated Thrombogram~~ (~~CAT) test, as shown with in vitro studies on reversal of dabigatran and rivaroxaban. CAT measures coagulability by measuring the thrombin concentration of a sample~~. It is a fluorogenic assay that compares the concentration of thrombin in clotting plasma with a constant known thrombin activity in a parallel non-clotting sample. This test could potentially be a global test of coagulation state and is therefore potentially very useful in the clinical setting to assess patients with any possible coagulopathy.

	==Management==		==Management==
	*IV/O2/Monitor, ABCs		*IV/O2/Monitor, ABCs
	*~~standard~~ resuscitation with IVF; PRBCs if needed		*Standard resuscitation with IVF; PRBCs if needed
	*If [[ICH]], treat for [[increased ICP]]		*If [[ICH]], treat for [[increased ICP]]
	*Currently published manuscripts and protocols is that either [[PCC]] or aPCC is recommended as a reversal agent for DTIs and FXa inhibitors, with no clear data as to which is superior.		*Currently published manuscripts and protocols is that either [[PCC]] or aPCC is recommended as a reversal agent for DTIs and FXa inhibitors, with no clear data as to which is superior.
Line 32:		Line 30:
	==Disposition==		==Disposition==
	*admission to a monitored setting		*admission to a monitored setting

	==See Also==		==See Also==
	*[[Anticoagulant reversal for life-threatening bleeds]]		*[[Anticoagulant reversal for life-threatening bleeds]]

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T01:22:06Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 01:22, 25 July 2016
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	*spontaneous bleeding		*spontaneous bleeding

	==~~Diagnosis~~==		==Evaluation==
	*clinical manifestation of GI bleeding		*clinical manifestation of GI bleeding
	*low H&H		*low H&H

Neil.m.young: Text replacement - "* " to "*"

2016-07-04T22:28:21Z

Text replacement - "* " to "*"

← Older revision		Revision as of 22:28, 4 July 2016
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	==Background==		==Background==
	* Millions of people in the United States are on at least one type of anticoagulant medication, for a number of medical conditions including atrial fibrillation, placement of cardiac stents, stroke prevention, deep vein thrombosis/pulmonary embolism, and prevention of acute coronary syndromes.		*Millions of people in the United States are on at least one type of anticoagulant medication, for a number of medical conditions including atrial fibrillation, placement of cardiac stents, stroke prevention, deep vein thrombosis/pulmonary embolism, and prevention of acute coronary syndromes.
	* In the past several years, there have been numerous new anticoagulant medications that have entered the market, with claims of easier dosing and need for less monitoring compared to older generation medications.		*In the past several years, there have been numerous new anticoagulant medications that have entered the market, with claims of easier dosing and need for less monitoring compared to older generation medications.
	* However, with use of these new medications in increasing numbers by the public, and uncertainty regarding the best mechanisms of reversal, this can lead to a difficult situation for the emergency physician when a patient on one of these medications presents with a catastrophic intracranial or gastrointestinal bleed.		*However, with use of these new medications in increasing numbers by the public, and uncertainty regarding the best mechanisms of reversal, this can lead to a difficult situation for the emergency physician when a patient on one of these medications presents with a catastrophic intracranial or gastrointestinal bleed.
	* Since the introduction of the direct thrombin inhibitor (DTI) dabigatran (Pradaxa) and the Factor Xa inhibitors rivaroxaban (Xarelto) and epixiban (Eliquis), there have been multiple studies that have attempted to determine 1) which test(s) could be used to assess whether a patient has supratherapeutic drug levels, and 2) the best way to reverse anticoagulation in patients on these medications who have a life-threatening bleed.		*Since the introduction of the direct thrombin inhibitor (DTI) dabigatran (Pradaxa) and the Factor Xa inhibitors rivaroxaban (Xarelto) and epixiban (Eliquis), there have been multiple studies that have attempted to determine 1) which test(s) could be used to assess whether a patient has supratherapeutic drug levels, and 2) the best way to reverse anticoagulation in patients on these medications who have a life-threatening bleed.
	* However, the available studies are lacking in that none of these studies are assessing human subjects taking these medicaitions who are potentially supratherapeutic and symptomatic.		*However, the available studies are lacking in that none of these studies are assessing human subjects taking these medicaitions who are potentially supratherapeutic and symptomatic.

	==Clinical Features==		==Clinical Features==
	* Patient taking rivaroxaban with a life-threatening bleeding event (GI, ICH, etc.)		*Patient taking rivaroxaban with a life-threatening bleeding event (GI, ICH, etc.)

	==Differential Diagnosis==		==Differential Diagnosis==
	* bleeding secondary to other coagulopathy		*bleeding secondary to other coagulopathy
	* spontaneous bleeding		*spontaneous bleeding

	==Diagnosis==		==Diagnosis==
	* clinical manifestation of GI bleeding		*clinical manifestation of GI bleeding
	* low H&H		*low H&H
	* non contrast head CT showing ICH		*non contrast head CT showing ICH
	* Factor Xa inhibiting agents affect the PT, however the degree of PT elevation does not directly correlate with that produced by warfarin and is not reliable in assessing level of anticoagulation with rivaroxaban or epixaban.		*Factor Xa inhibiting agents affect the PT, however the degree of PT elevation does not directly correlate with that produced by warfarin and is not reliable in assessing level of anticoagulation with rivaroxaban or epixaban.
	* Antifactor Xa assays can be performed but the test needs to be calibrated specifically for these drugs, rather than using the calibration scale for LMWH, in order for the results to be reliable. However, Antifactor Xa assays measure drug levels and not degree of coagulopathy.		*Antifactor Xa assays can be performed but the test needs to be calibrated specifically for these drugs, rather than using the calibration scale for LMWH, in order for the results to be reliable. However, Antifactor Xa assays measure drug levels and not degree of coagulopathy.
	* One test that has shown promise in determining level of coagulopathy and reversal of coagulopathy with both DTIs and Xa inhibitors is the Calibrated Automated Thrombogram (CAT) test, as shown with in vitro studies on reversal of dabigatran and rivaroxaban. CAT measures coagulability by measuring the thrombin concentration of a sample. It is a fluorogenic assay that compares the concentration of thrombin in clotting plasma with a constant known thrombin activity in a parallel non-clotting sample. This test could potentially be a global test of coagulation state and is therefore potentially very useful in the clinical setting to assess patients with any possible coagulopathy.		*One test that has shown promise in determining level of coagulopathy and reversal of coagulopathy with both DTIs and Xa inhibitors is the Calibrated Automated Thrombogram (CAT) test, as shown with in vitro studies on reversal of dabigatran and rivaroxaban. CAT measures coagulability by measuring the thrombin concentration of a sample. It is a fluorogenic assay that compares the concentration of thrombin in clotting plasma with a constant known thrombin activity in a parallel non-clotting sample. This test could potentially be a global test of coagulation state and is therefore potentially very useful in the clinical setting to assess patients with any possible coagulopathy.

	==Management==		==Management==
	* IV/O2/Monitor, ABCs		*IV/O2/Monitor, ABCs
	* standard resuscitation with IVF; PRBCs if needed		*standard resuscitation with IVF; PRBCs if needed
	* If [[ICH]], treat for [[increased ICP]]		*If [[ICH]], treat for [[increased ICP]]
	* Currently published manuscripts and protocols is that either [[PCC]] or aPCC is recommended as a reversal agent for DTIs and FXa inhibitors, with no clear data as to which is superior.		*Currently published manuscripts and protocols is that either [[PCC]] or aPCC is recommended as a reversal agent for DTIs and FXa inhibitors, with no clear data as to which is superior.
	* Consider Tranexamic acid		*Consider Tranexamic acid

	{{Factor Xa Inhibitor Reversal}}		{{Factor Xa Inhibitor Reversal}}

	==Disposition==		==Disposition==
	* admission to a monitored setting		*admission to a monitored setting
	==See Also==		==See Also==
	*[[Anticoagulant reversal for life-threatening bleeds]]		*[[Anticoagulant reversal for life-threatening bleeds]]

Mihhwang at 11:01, 6 May 2016

2016-05-06T11:01:02Z

← Older revision		Revision as of 11:01, 6 May 2016
Line 26:		Line 26:
	* If [[ICH]], treat for [[increased ICP]]		* If [[ICH]], treat for [[increased ICP]]
	* Currently published manuscripts and protocols is that either [[PCC]] or aPCC is recommended as a reversal agent for DTIs and FXa inhibitors, with no clear data as to which is superior.		* Currently published manuscripts and protocols is that either [[PCC]] or aPCC is recommended as a reversal agent for DTIs and FXa inhibitors, with no clear data as to which is superior.
			* Consider Tranexamic acid

	{{Factor Xa Inhibitor Reversal}}		{{Factor Xa Inhibitor Reversal}}

Rossdonaldson1: /* References */

2016-04-28T13:18:10Z

References

← Older revision		Revision as of 13:18, 28 April 2016
Line 69:		Line 69:
	#Yates, S., & Sarode, R. (2013). Novel thrombin and factor Xa inhibitors. Current Opinion In Hematology, 20(6), 552-557. doi:10.1097/moh.0b013e328365a164		#Yates, S., & Sarode, R. (2013). Novel thrombin and factor Xa inhibitors. Current Opinion In Hematology, 20(6), 552-557. doi:10.1097/moh.0b013e328365a164
	#Zumberg, M., Rajasekhar, A., Lawson, M., & Khanna, A. (2013). . Retrieved 7 September 2014, from https://com-dom-hemonc.sites.medinfo.ufl.edu/files/2012/02/Anticoag-reversal-in-ICH-2013-2.pdf		#Zumberg, M., Rajasekhar, A., Lawson, M., & Khanna, A. (2013). . Retrieved 7 September 2014, from https://com-dom-hemonc.sites.medinfo.ufl.edu/files/2012/02/Anticoag-reversal-in-ICH-2013-2.pdf

			[[Category:Heme/Onc]]

Rossdonaldson1: /* Management */

2016-04-28T13:13:58Z

Management

← Older revision		Revision as of 13:13, 28 April 2016
Line 26:		Line 26:
	* If [[ICH]], treat for [[increased ICP]]		* If [[ICH]], treat for [[increased ICP]]
	* Currently published manuscripts and protocols is that either [[PCC]] or aPCC is recommended as a reversal agent for DTIs and FXa inhibitors, with no clear data as to which is superior.		* Currently published manuscripts and protocols is that either [[PCC]] or aPCC is recommended as a reversal agent for DTIs and FXa inhibitors, with no clear data as to which is superior.

			{{Factor Xa Inhibitor Reversal}}

	==Disposition==		==Disposition==

Rossdonaldson1: /* See Also */

2016-04-28T13:11:34Z

Rossdonaldson1: /* See Also */

2016-01-12T08:40:27Z

Rossdonaldson1: /* References */

2016-01-12T08:39:45Z

References

← Older revision		Revision as of 13:11, 28 April 2016
Line 30:		Line 30:
	* admission to a monitored setting		* admission to a monitored setting
	==See Also==		==See Also==
	*[[~~Coagulopathy (main)~~]]		*[[Anticoagulant reversal for life-threatening bleeds]]

	==External Links==		==External Links==

← Older revision		Revision as of 08:40, 12 January 2016
Line 30:		Line 30:
	* admission to a monitored setting		* admission to a monitored setting
	==See Also==		==See Also==
			*[[Coagulopathy (main)]]

	==External Links==		==External Links==

← Older revision		Revision as of 08:39, 12 January 2016
Line 34:		Line 34:

	==References==		==References==
	*1. Akwaa, F., & Spyropoulos, A. (2013). Treatment of Bleeding Complications When Using Oral Anticoagulants for Prevention of Strokes. Current Treatment Options In Cardiovascular Medicine, 15(3), 288-298. doi:10.1007/s11936-013-0238-5		#Akwaa, F., & Spyropoulos, A. (2013). Treatment of Bleeding Complications When Using Oral Anticoagulants for Prevention of Strokes. Current Treatment Options In Cardiovascular Medicine, 15(3), 288-298. doi:10.1007/s11936-013-0238-5
	*2. Awad, N., & Cocchio, C. (2013). Activated Prothrombin Complex Concentrates for the Reversal of Anticoagulant-Associated Coagulopathy. Pharmacy And Therapeutics, 38(11), 696.		#Awad, N., & Cocchio, C. (2013). Activated Prothrombin Complex Concentrates for the Reversal of Anticoagulant-Associated Coagulopathy. Pharmacy And Therapeutics, 38(11), 696.
	*3. Babilonia, K., & Trujillo, T. (2014). The role of prothrombin complex concentrates in reversal of target specific anticoagulants. Thrombosis Journal, 12(1), 8. doi:10.1186/1477-9560-12-8		#Babilonia, K., & Trujillo, T. (2014). The role of prothrombin complex concentrates in reversal of target specific anticoagulants. Thrombosis Journal, 12(1), 8. doi:10.1186/1477-9560-12-8
	*4. Davis, P., Musunuru, H., Walsh, M., Mitra, R., Ploplis, V., & Castellino, F. (2012). The ex vivo reversibility of dabigatran-induced whole-blood coagulopathy as monitored by thromboelastography: Mechanistic implications for clinical medicine. Thromb Haemost, 108(3), 586-588. doi:10.1160/th12-04-0222		#Davis, P., Musunuru, H., Walsh, M., Mitra, R., Ploplis, V., & Castellino, F. (2012). The ex vivo reversibility of dabigatran-induced whole-blood coagulopathy as monitored by thromboelastography: Mechanistic implications for clinical medicine. Thromb Haemost, 108(3), 586-588. doi:10.1160/th12-04-0222
	*5. Ebright, J., & Mousa, S. (2014). Oral Anticoagulants and Status of Antidotes for the Reversal of Bleeding Risk. Clinical And Applied Thrombosis/Hemostasis. doi:10.1177/1076029614545211		#Ebright, J., & Mousa, S. (2014). Oral Anticoagulants and Status of Antidotes for the Reversal of Bleeding Risk. Clinical And Applied Thrombosis/Hemostasis. doi:10.1177/1076029614545211
	*6. Eerenberg, E., Kamphuisen, P., Sijpkens, M., Meijers, J., Buller, H., & Levi, M. (2011). Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate: A Randomized, Placebo-Controlled, Crossover Study in Healthy Subjects. Circulation, 124(14), 1573-1579. doi:10.1161/circulationaha.111.029017		#Eerenberg, E., Kamphuisen, P., Sijpkens, M., Meijers, J., Buller, H., & Levi, M. (2011). Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate: A Randomized, Placebo-Controlled, Crossover Study in Healthy Subjects. Circulation, 124(14), 1573-1579. doi:10.1161/circulationaha.111.029017
	*7. Fawole, A., Daw, H., & Crowther, M. (2013). Practical management of bleeding due to the anticoagulants dabigatran, rivaroxaban, and apixaban. Cleveland Clinic Journal Of Medicine, 80(7), 443-451. doi:10.3949/ccjm.80a.13025		#Fawole, A., Daw, H., & Crowther, M. (2013). Practical management of bleeding due to the anticoagulants dabigatran, rivaroxaban, and apixaban. Cleveland Clinic Journal Of Medicine, 80(7), 443-451. doi:10.3949/ccjm.80a.13025
	*8. Ferrandis, R., Castillo, J., de AndrÃ©s, J., Gomar, C., GÃ³mez-Luque, A., & Hidalgo, F. et al. (2013). The perioperative management of new direct oral anticoagulants: a question without answers. Thromb Haemost, 110(3), 515-522. doi:10.1160/th12-11-0868		#Ferrandis, R., Castillo, J., de AndrÃ©s, J., Gomar, C., GÃ³mez-Luque, A., & Hidalgo, F. et al. (2013). The perioperative management of new direct oral anticoagulants: a question without answers. Thromb Haemost, 110(3), 515-522. doi:10.1160/th12-11-0868
	*9. Gordon, J., Fabian, T., Lee, M., & Dugdale, M. (2013). Anticoagulant and antiplatelet medications encountered in emergency surgery patients. Journal Of Trauma And Acute Care Surgery, 75(3), 475-486. doi:10.1097/ta.0b013e3182a07391		#Gordon, J., Fabian, T., Lee, M., & Dugdale, M. (2013). Anticoagulant and antiplatelet medications encountered in emergency surgery patients. Journal Of Trauma And Acute Care Surgery, 75(3), 475-486. doi:10.1097/ta.0b013e3182a07391
	*10. Hankey, G., & Eikelboom, J. (2011). Dabigatran Etexilate: A New Oral Thrombin Inhibitor. Circulation, 123(13), 1436-1450. doi:10.1161/circulationaha.110.004424		#Hankey, G., & Eikelboom, J. (2011). Dabigatran Etexilate: A New Oral Thrombin Inhibitor. Circulation, 123(13), 1436-1450. doi:10.1161/circulationaha.110.004424
	*11. Herrmann, R., Thom, J., Wood, A., Phillips, M., Muhammad, S., & Baker, R. (2013). Thrombin generation using the calibrated automated thrombinoscope to assess reversibility of dabigatran and rivaroxaban. Thromb Haemost, 111(5), 989-995. doi:10.1160/th13-07-0607		#Herrmann, R., Thom, J., Wood, A., Phillips, M., Muhammad, S., & Baker, R. (2013). Thrombin generation using the calibrated automated thrombinoscope to assess reversibility of dabigatran and rivaroxaban. Thromb Haemost, 111(5), 989-995. doi:10.1160/th13-07-0607
	*12. James, R., Palys, V., Lomboy, J., Lamm, J., & Simon, S. (2013). The role of anticoagulants, antiplatelet agents, and their reversal strategies in the management of intracerebral hemorrhage. Neurosurgical Focus, 34(5), E6. doi:10.3171/2013.2.focus1328		#James, R., Palys, V., Lomboy, J., Lamm, J., & Simon, S. (2013). The role of anticoagulants, antiplatelet agents, and their reversal strategies in the management of intracerebral hemorrhage. Neurosurgical Focus, 34(5), E6. doi:10.3171/2013.2.focus1328
	*13. Kaatz, S., & Crowther, M. (2013). Reversal of target-specific oral anticoagulants. J Thromb Thrombolysis, 36(2), 195-202. doi:10.1007/s11239-013-0923-y		#Kaatz, S., & Crowther, M. (2013). Reversal of target-specific oral anticoagulants. J Thromb Thrombolysis, 36(2), 195-202. doi:10.1007/s11239-013-0923-y
	*14. Kasliwal, M., Panos, N., Munoz, L., Moftakhar, R., Lopes, D., & Byrne, R. (2014). Outcome following intracranial hemorrhage associated with novel oral anticoagulants. Journal Of Clinical Neuroscience. doi:10.1016/j.jocn.2014.04.025		#Kasliwal, M., Panos, N., Munoz, L., Moftakhar, R., Lopes, D., & Byrne, R. (2014). Outcome following intracranial hemorrhage associated with novel oral anticoagulants. Journal Of Clinical Neuroscience. doi:10.1016/j.jocn.2014.04.025
	*15. Khoo, T., Weatherburn, C., Kershaw, G., Reddel, C., Curnow, J., & Dunkley, S. (2012). The use of FEIBA® in the correction of coagulation abnormalities induced by dabigatran. International Journal Of Laboratory Hematology, 35(2), 222-224. doi:10.1111/ijlh.12005		#Khoo, T., Weatherburn, C., Kershaw, G., Reddel, C., Curnow, J., & Dunkley, S. (2012). The use of FEIBA® in the correction of coagulation abnormalities induced by dabigatran. International Journal Of Laboratory Hematology, 35(2), 222-224. doi:10.1111/ijlh.12005
	*16. Lai, A., Davidson, N., Galloway, S., & Thachil, J. (2014). Perioperative management of patients on new oral anticoagulants. British Journal Of Surgery, 101(7), 742-749. doi:10.1002/bjs.9485		#Lai, A., Davidson, N., Galloway, S., & Thachil, J. (2014). Perioperative management of patients on new oral anticoagulants. British Journal Of Surgery, 101(7), 742-749. doi:10.1002/bjs.9485
	*17. Lambe, S. (2013). Reversing the New Anticoagulants. Retrieved 7 September 2014, from http://www.ucsfcme.com/2014/MEM14001/slides/24LambeTheNewAnticoagulants.pdf		#Lambe, S. (2013). Reversing the New Anticoagulants. Retrieved 7 September 2014, from http://www.ucsfcme.com/2014/MEM14001/slides/24LambeTheNewAnticoagulants.pdf
	*18. Lazo-Langner, A., Lang, E., & Douketis, J. (2013). Clinical review: Clinical management of new oral anticoagulants: a structured review with emphasis on the reversal of bleeding complications. Critical Care, 17(3), 230. doi:10.1186/cc12592		#Lazo-Langner, A., Lang, E., & Douketis, J. (2013). Clinical review: Clinical management of new oral anticoagulants: a structured review with emphasis on the reversal of bleeding complications. Critical Care, 17(3), 230. doi:10.1186/cc12592
	*19. Levine, M., & Goldstein, J. (2014). Emergency Reversal of Anticoagulation: Novel Agents. Current Neurology And Neuroscience Reports, 14(8). doi:10.1007/s11910-014-0471-7		#Levine, M., & Goldstein, J. (2014). Emergency Reversal of Anticoagulation: Novel Agents. Current Neurology And Neuroscience Reports, 14(8). doi:10.1007/s11910-014-0471-7
	*20. Luddington, R., & Baglin, T. (2004). Clinical measurement of thrombin generation by calibrated automated thrombography requires contact factor inhibition. Journal Of Thrombosis And Haemostasis, 2(11), 1954--1959.		#Luddington, R., & Baglin, T. (2004). Clinical measurement of thrombin generation by calibrated automated thrombography requires contact factor inhibition. Journal Of Thrombosis And Haemostasis, 2(11), 1954--1959.
	*21. Majeed, A., & Schulman, S. (2013). Bleeding and antidotes in new oral anticoagulants. Best Practice & Research Clinical Haematology, 26(2), 191-202. doi:10.1016/j.beha.2013.07.001		#Majeed, A., & Schulman, S. (2013). Bleeding and antidotes in new oral anticoagulants. Best Practice & Research Clinical Haematology, 26(2), 191-202. doi:10.1016/j.beha.2013.07.001
	*22. Mancl, E., Crawford, A., & Voils, S. (2012). Contemporary Anticoagulation Reversal: Focus on Direct Thrombin Inhibitors and Factor Xa Inhibitors. Journal Of Pharmacy Practice, 26(1), 43-51. doi:10.1177/0897190012465989		#Mancl, E., Crawford, A., & Voils, S. (2012). Contemporary Anticoagulation Reversal: Focus on Direct Thrombin Inhibitors and Factor Xa Inhibitors. Journal Of Pharmacy Practice, 26(1), 43-51. doi:10.1177/0897190012465989
	*23. Miller, M., Trujillo, T., & Nordenholz, K. (2014). Practical considerations in emergency management of bleeding in the setting of target-specific oral anticoagulants. The American Journal Of Emergency Medicine, 32(4), 375-382. doi:10.1016/j.ajem.2013.11.044		#Miller, M., Trujillo, T., & Nordenholz, K. (2014). Practical considerations in emergency management of bleeding in the setting of target-specific oral anticoagulants. The American Journal Of Emergency Medicine, 32(4), 375-382. doi:10.1016/j.ajem.2013.11.044
	*24. Mittal, M., & Rabinstein, A. (2012). Anticoagulation-Related Intracranial Hemorrhages. Current Atherosclerosis Reports, 14(4), 351-359. doi:10.1007/s11883-012-0258-8		#Mittal, M., & Rabinstein, A. (2012). Anticoagulation-Related Intracranial Hemorrhages. Current Atherosclerosis Reports, 14(4), 351-359. doi:10.1007/s11883-012-0258-8
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