Fig. 3

DOAC-induced anticoagulation and the proposed effect of PCCs. Figure legend: Direct inhibitors of FXa or thrombin (FIIa) affect both initiation and propagation of thrombin generation. FIIa inhibitors (e.g. dabigatran) directly inhibit the FIIa that is formed (a), while FXa inhibitors (e.g. rivaroxaban, edoxaban, apixaban) reduce the amount of thrombin generated by FXa (b). PCCs are thought to mitigate the anticoagulant effect of FXa or FIIa inhibitors, by increasing the levels of non-activated clotting factors (c), predominantly FII, FIX and FX, which can be activated in case of an active bleed. F, factor; FGN, fibrinogen; DOAC, non-vitamin K antagonist oral anticoagulant; PCC, prothrombin complex concentrate; TF, tissue factor; vWF, von Willebrand factor