What additional treatment might be considered for DOAC overdose if bleeding occurs?

In cases of direct oral anticoagulant (DOAC) overdose leading to bleeding, one of the additional treatments that can be considered is intravenous tranexamic acid. Tranexamic acid is an antifibrinolytic agent that works by inhibiting the breakdown of fibrin, which can help stabilize blood clots and reduce bleeding in patients. This can be particularly useful in situations where there is significant bleeding as a result of coagulation disturbances due to the effects of DOACs.

Using tranexamic acid can provide a rapid intervention to control bleeding while waiting for other reversal agents or supportive measures to take effect. It is important to note that tranexamic acid does not reverse the anticoagulant effects of DOACs, but it can assist in managing the complications associated with the bleeding.

The other treatments listed do not serve the purpose of managing bleeding specifically related to DOAC overdoses. Oral aspirin could potentially increase bleeding risk, IV heparin would add further anticoagulation effects rather than counteracting them, and IV norepinephrine is primarily a vasopressor used in cases of shock and does not address the underlying issue of bleeding due to anticoagulation. Thus, tranexamic acid is the most appropriate option in this scenario.