Thrombin inhibitor dabigatran and factor Xa inhibitors rivaroxaban, apixaban and 
edoxaban form a new class of non-vitamin K antagonist oral anticoagulants and 
have been extensively studied in patients with venous thromboembolism and atrial 
fibrillation. They offer anticoagulation that is as effective and at least as 
safe compared to warfarin without the need for routine laboratory monitoring; 
however, no reversal strategies are currently validated in case of a non-vitamin 
K antagonist oral anticoagulant-associated bleed. In emergency situations, 
laboratory drug measurement and well-defined management for non-vitamin K 
antagonist oral anticoagulant-induced hemorrhage may improve clinical outcome. 
In this review, the merits and limitations of the routine coagulation tests and 
some of the more specific laboratory assays are compared. Furthermore, 
prohemostatic measures are reviewed and the recommended strategies in case of 
bleeding are summarized. Specific reversal agents are currently under 
development (idarucizumab for dabigatran, andexanet alfa for Xa inhibitors, and 
PER977 for both Xa- and thrombin inhibitors), which will facilitate clinical 
management of severe bleeding and emergency surgery.