Non–vitamin K antagonist oral anticoagulant reversal: hope is on the horizon

•Prothrombin complex concentrates may assist in reversal of NOACs in a nonspecific manner.•Idarucizumab has shown efficacy approved by the Food and Drug Administration (FDA) for reversal of dabigatran.•Andexanet alfa has completed phase III trials for the reversal of factor Xa inhibitors and is awaiting FDA approval.•Aripazine (PER977) is a universal reversal agent that is awaiting FDA approval.

BackgroundNon–vitamin K oral anticoagulants have become an attractive alternative to warfarin when patients require anticoagulation. Until recently, one of the biggest challenges to these agents was the lack of specific reversal of their anticoagulation when bleeding occurs or urgent/emergent procedures are required.Data SourcesThis article is a narrative review of peer-reviewed publications with particular attention to authors that are experts in the field, society guidelines, and government publications.ConclusionsDevelopment of several drugs has led to agent-specific reversal. Idarucizumab has gained approval in the United States for reversal of dabigatran. Andexanet alfa has completed promising phase III trials for the reversal of factor Xa inhibitors. Aripazine (PER977) has shown promise as a universal reversal agent against non–vitamin K antagonist oral anticoagulants and heparin products.