Dabigatran was the first direct acting oral anticoagulant (DOAC) launched in the UK and has been in clinical use for over 10 years. Since then, ▾rivaroxaban, apixaban and ▾edoxaban have been marketed, and between them the four DOACs account for over 800 000 prescriptions per month in England.1 DOACs provide some advantages over warfarin, including a rapid onset of action, predictable dose–response with fixed doses and limited interactions with food and drugs. Nevertheless, there are still well-recognised problems with bleeding and at present there are only limited therapeutic options available to reverse their anticoagulant effect.2 Since their launch, the Medicines and Healthcare products Regulatory Agency (MHRA) has received more than 4 000 yellow card reports of DOAC-associated haemorrhagic adverse events of which almost 500 were fatal.3

All the DOACs are dependent on …