The non-vitamin K antagonist oral anticoagulants (NOACs) are used for 
thromboembolic prophylaxis of patients with atrial fibrillation and in the 
treatment as well as secondary prophylaxis of patients with venous 
thromboembolism. Even though NOACs have a better safety profile than vitamin K 
antagonists (VKAs), there will still be bleeding complications on NOAC 
treatment. In some cases, stopping the NOAC and non-drug-related management such 
as manual compression and interventional endoscopy will be sufficient to stop 
the bleeding. In more serious bleeding events and before acute surgery, 
coagulation factor concentrates or NOAC-specific antidotes could be used. 
Coagulation factor concentrates can be used in patients with haemophilia and to 
reverse the effect of VKAs but, in NOAC-treated patients, results are 
inconsistent and these agents could potentially have pro-thrombotic effects. 
Specific antidotes for NOACs are expected to be on the market soon. Phase III 
clinical trials with a humanized antibody fragment directed against dabigatran 
(idarucizumab) and recombinant, modified factor Xa (andexanet alfa) are ongoing. 
A molecule (aripazine) with broad activity against various anticoagulants 
including NOACs is currently undergoing phase II trials. For use of these 
specific antidotes, it is desirable that measurements for coagulation activity 
with a short response delay are widely available for the different NOACs and 
further research in this field is needed. Furthermore, guidelines for antidote 
use, including general measures for the treatment of NOAC-related bleeding, 
should be available.