Newly Published
Clinical Focus Review  |   August 2019
Four-factor Prothrombin Complex Concentrate for the Management of Patients Receiving Direct Oral Activated Factor X Inhibitors
Author Notes
  • From the Department of Anesthesiology, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Germany (O.G.); Thrombosis and Atherosclerosis Research Institute and Department of Medicine, McMaster University, Hamilton, Canada (S.S.); and Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Russia (S.S.).
  • Submitted for publication November 5, 2019. Accepted for publication July 1, 2019.
    Submitted for publication November 5, 2019. Accepted for publication July 1, 2019.×
  • Correspondence: Address correspondence to Dr. Schulman: Thrombosis Service, HHS-General Hospital, 237 Barton Street East, Hamilton, Ontario, L8L 2X2, Canada. schulms@mcmaster.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Coagulation and Transfusion / Clinical Focus Review
Clinical Focus Review   |   August 2019
Four-factor Prothrombin Complex Concentrate for the Management of Patients Receiving Direct Oral Activated Factor X Inhibitors
Anesthesiology Newly Published on August 12, 2019. doi:10.1097/ALN.0000000000002910
Anesthesiology Newly Published on August 12, 2019. doi:10.1097/ALN.0000000000002910
Direct oral anticoagulants (DOACs) have been approved for the prevention of stroke and systemic embolism in atrial fibrillation, treatment and secondary prevention of venous thromboembolism (VTE), and thromboprophylaxis after major orthopedic surgery. DOACs achieve anticoagulation by inhibiting specific coagulation factors; apixaban, betrixaban, edoxaban, and rivaroxaban inhibit activated factor X, whereas dabigatran inhibits thrombin (factor IIa). In contrast to vitamin K antagonists (VKAs) such as warfarin, DOACs have more predictable pharmacokinetics and pharmacodynamics and fewer interactions with other medications and food, and they are not associated with the problems of a narrow therapeutic window like warfarin.1–3  This allows for fixed oral dosing once or twice per day, without the need for anticoagulation monitoring or dose adjustments.