Reversal agents for direct oral anticoagulants (DOACs), including factor X inhibitors and direct thrombin inhibitors, are a major concern in clinical practice. After DOACs were introduced and became widely used as an alternative for vitamin K antagonists in the management of venous thromboembolism and nonvalvular atrial fibrillation, the need for effective reversal agents has increased, particularly for life-threatening bleeding episodes related to DOACs or to reverse medication effects during urgent interventions. In the absence of specific reversal agents, prothrombin complex concentrate (PCC) and activated PCC are reasonable options to reverse bleeding associated with DOACs. However, high-quality clinical evidence is lacking. Idarucizumab is the only agent approved by the US Food and Drug Administration to reverse the effects of dabigatran; andexanet alfa and ciraparantag are also under evaluation as reversal agents for DOACs. This review summarizes the current evidence for nonspecific and specific reversal of DOACs.

Venous thromboembolism after total knee and hip arthroplasty. A retrospective study

Cerebral venous thrombosis (CVT) is a rare cause of cerebral infarction, accounting for <1% of stroke cases worldwide. The pathophysiology of CVT is multifactorial, encompassing the direct effects of thrombosis, interference with the blood–brain barrier and development of cerebral edema. Several genetic and acquired risk factors of CVT have been identified, more recently this includes the pro-thrombotic effects of coronavirus disease of 2019 infection. CVT can present with wide variation of clinical characteristics, with headache being the most common clinical manifestation. Diagnosis is based on radiological imaging. The mainstay of CVT management is prompt initiation of anti-coagulation. Failure to recognize insidious symptoms of CVT, will lead to a delay in diagnosis and consequently treatment which eventually lead to significant complications, including neurological disability and death. The aim of this narrative review is to consolidate the existing knowledge on CVT, a rare condition with a challenging diagnosis and treatment.

Venous thromboembolism is one of the complications in patients prescribed antipsychotic medications. Neuroleptic malignant syndrome (NMS) is a rare side effect of antipsychotic medications in this population. In this case, a young patient, who presented with NMS after a recent start of antipsychotic medications, had developed a pulmonary embolism despite standard of care measures of venous thromboprophylaxis and early mobilization. A low threshold of VTE suspicion and effective preventive measures are both required in order to avoid this preventable complication in this population.

Objectives: To assess outcomes and complications of patients with cerebral venous thrombosis (CVT). Methods: This multicenter retrospective study was conducted at 2 health care centers in Saudi Arabia and Oman. Adult patients diagnosed with CVT in radiological imaging between 2006 and 2020 were included. Data were collected from medical records and analyzed using the software IBM® SPSS version 22. Neurological disability occurring after CVT was graded according to the modified Rankin scale (mRS). Results: The study included 103 patients, of which the majority (68%) were female. The mean age was 39.12±12.96 years. Two-thirds of patients received low-molecular-weight heparin (LMWH) in acute treatment, while 76% of discharged patients used warfarin. The majority of patients had no or mild neurological disability during follow-up, and 6 patients had an mRS score ≥3, implying significant neurological disability. There were 55 patients (52.3%) who had complications from CVT, including seizures in 17 (16.5%) patients and one mortality. Follow-up imaging of 55 patients showed complete thrombus resolution in 20 patients (36%). Conclusion: Anticoagulation is the mainstay treatment for CVT patients. Approximately half of patients experience complications. Prospective studies are needed to assess the long-term neurological outcomes in such patients.