Asking patients when they took their last dose of NOAC is often the most practical method for quickly assessing residual anticoagulant activity. Nonspeci c Hemostatic Agents: Hemostatic factors that have been studied as potential nonspeci c NOAC reversal agents including PCCs, activated PCC, recombinant activated factor VII, and fresh-frozen plasma. PCCs are the preferred nonspeci c hemostatic agent for NOAC reversal. PCCs are plasma-derived products that contain 3 (factors II, IX, and X) or 4 (addition of factor VII) clotting factors in addition to variable amounts of heparin and the natural coagulation inhibitors protein C and protein S. Animal studies have demonstrated that PCCs have variable ability to normalize anticoagulation parameters and prevent or 1160 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] TABLE 6 ] A Simpli ed Schema to Assist Physician Choice of Anticoagulant (VKA or Individual NOAC) According to Patient Characteristics Patient Characteristic Possible OAC Choice References to RCT Subgroup Data References to Real-World Data or Indirect Evidence Comments  Recurrent ischemic stroke/systemic embolism/TIA despite good anticoagulation control (TTR $ 70%). Consider agent with superior ef cacy for preventing both ischemic and hemorrhagic stroke D150 124 127 In general, any NOAC would be recommended, especially where warfarin control suboptimal (TTR < 65%). Ensure good adherence and avoid underdosing  Moderate-severe renal impairment CrCl 15-49 mL/min Aa Db R15 124 192 All RCTs excluded patients with Cockroft-Gault CrCl < 30 mL/min (< 25 mL/min, for apixaban)  High risk of GI bleeding A D110 124 127, 193  Major GI symptoms or dyspepsia. Also consider increased risk of bleeding  High risk of bleeding (HAS-BLED $ 3). 