The direct thrombin inhibitor dabigatran and the anti-Xa agents rivaroxaban, 
edoxaban, and apixaban are a new generation of oral anticoagulants. Their 
advantage over the vitamin K antagonists is the lack of the need for monitoring 
and dose adjustment. Their main disadvantage is currently the absence of a 
specific reversal agent. Dabigatran's, unlike the anti-Xa agents, absorption can 
be reduced by activated charcoal if administered shortly after ingestion and it 
can be removed from the blood with hemodialysis. Prothrombin complex 
concentrate, activated prothrombin complex concentrate, and recombinant factor 
VIIa all show some activity in reversing the anticoagulant effect of these drugs 
but this is based on ex vivo, animal, and volunteer studies. It is unclear, 
which, if any, of these drugs is the most suitable for emergency reversal. Three 
novel molecules (idarucizumab, andexanet, and PER977) may provide the most 
effective and safest way of reversal. These agents are currently in premarketing 
studies.