Novel oral anticoagulants (NOACs) that directly inhibit thrombin (dabigatran) or 
factor Xa (rivaroxaban, apixaban, edoxaban) are effective therapies for the 
prevention and treatment of thromboembolism with reduced bleeding complications 
compared with warfarin for some indications. However, specific antidotes to 
reverse the anticoagulant activity of NOACs in the event of major bleeding are 
not available. Evidence supporting non-specific prohemostatic therapies 
(prothrombin complex concentrate [PCC], activated prothrombin complex 
concentrate [aPCC], recombinant factor VIIa) in this setting is limited to 
healthy human volunteers, animal models, and in vitro studies. Clinical outcome 
data are lacking. Administration of PCC or aPCC may be considered in addition to 
supportive measures for patients with severe or life-threatening bleeding. 
Clinical studies are needed to establish the efficacy and safety of these 
treatments. Target-specific antidotes are in development and hold promise for 
NOAC reversal, but require further investigation.