Knowledge and Practice of Oral Anticoagulation Reversal Among Malaysian Government Healthcare Professionals: A Nationwide Survey

OBJECTIVES

Despite established recommendations, variability remains in the prescribing and utilisation of oral anticoagulant (OAC) reversal agents. This study aimed to assess the availability of reversal agents and evaluate the practice and knowledge of healthcare professionals (HCPs) in managing OAC reversal within Ministry of Health Malaysia hospitals.

MATERIALS AND METHODS

A cross-sectional, self-administered questionnaire was distributed to prescribers and pharmacists across state, major specialist and minor specialist hospitals between October 2024 and March 2025. Descriptive analyses were used to analyse responses.

RESULTS

A total of 473 prescribers and 943 pharmacists from 64 hospitals participated. Injection phytomenadione was available in all facilities; 58 hospitals (90.6%) stocked fresh frozen plasma (FFP), and about 80% reported access to four-factor prothrombin complex concentrate (4F-PCC). Only two hospitals had an institutional OAC reversal policy. More than half of respondents correctly identified clinical scenarios for phytomenadione; however, many selected it as first-line therapy for warfarin-induced life-threatening bleeding. Most respondents preferred 4F-PCC for direct OAC (DOAC) reversal and idarucizumab for dabigatran-related life-threatening bleeding. For urgent procedures reversal, HCPs commonly recommended phytomenadione for warfarin, 4F-PCC for DOACs, and idarucizumab for dabigatran. Confidence level of HCPs in managing warfarin reversal is higher than for DOAC reversal. Most HCPs recognised the advantages of PCC over FFP.

CONCLUSION

Notable gaps remain between knowledge and practice as well as institutional access to recommended reversal agents. Improved availability, standardised protocols, and adherence to current evidence-based guidelines are needed to optimise OAC reversal practices.