Pharmacologic Agents Used to Reverse the Anticoagulant Effect of Common Anticoagulants

James M. Wooten, PharmD; Steven T. Baldwin, MD


South Med J. 2022;115(3):220-226. 

In This Article

Abstract and Introduction


Numerous oral and parenteral anticoagulant drugs are now available for clinical use. Understanding the precise pharmacologic properties of each anticoagulant is imperative for those practitioners who prescribe these drugs, including knowing the current recommendations for reversing the anticoagulant effect of each anticoagulant. This review provides a brief description of the various anticoagulants used today and also discusses the pharmacologic properties of those drugs used to reverse the anticoagulant action of specific anticoagulants.


Anticoagulant use has increased dramatically in the past several years. There are now many well-accepted indications for their use, several of which have been approved by the US Food and Drug Administration (FDA). Some of this increased use of anticoagulants may result from the development of the novel oral anticoagulants (NOACs; also known as direct oral anticoagulants [DOACs]). The NOACs have been found to be equal or more effective than older anticoagulant drugs for many indications. In particular, NOACs often have more favorable pharmacologic properties and require less laboratory monitoring as compared with warfarin.[1–3]

The ability of anticoagulant drugs to prevent death or serious disability caused by thrombus formation is profoundly beneficial to patients at risk. Unfortunately, anticoagulants also are associated with a risk for fatal or severely disabling outcomes from bleeding. Significant comorbidities may substantially affect the risks and benefits of anticoagulants. Anticoagulants, therefore, must be used judiciously and monitored carefully. In addition, anticoagulants are commonly used in older adult patients and patients who have significant comorbidities, including hepatic and renal dysfunction. All of which can increase the risk of anticoagulant-induced hemorrhage due to falls, accidents, drug toxicity etc.[1,2]

It is essential for healthcare providers who prescribe anticoagulants to know the basic pharmacologic mechanism of each anticoagulant as well as have a thorough understanding of how the anticoagulant effect of each agent can be reversed, if necessary. There are now several different reversal agents that have been approved by the FDA to reverse the anticoagulant effects of the various anticoagulants currently available in the United States. Having a thorough knowledge of the specific reversal drug (rescue agent) that should be used, based on the type of anticoagulant prescribed, will ensure that patients, who depend on anticoagulants for chronic therapy, will be protected should an untoward bleeding event occur.[1–3]