Antidotes for novel oral anticoagulants: current status and future potential.
The direct thrombin inhibitor dabigatran and the anti-Xa agents rivaroxaban, edoxaban, and apixaban are a new generation of oral anticoagulants. Their advantage over the vitamin K antagonists is the lack of the need for monitoring and dose adjustment. Their main disadvantage is currently the absence of a specific reversal agent. Dabigatran's, unlike the anti-Xa agents, absorption can be reduced by activated charcoal if administered shortly after ingestion and it can be removed from the blood with hemodialysis. Prothrombin complex concentrate, activated prothrombin complex concentrate, and recombinant factor VIIa all show some activity in reversing the anticoagulant effect of these drugs but this is based on ex vivo, animal, and volunteer studies. It is unclear, which, if any, of these drugs is the most suitable for emergency reversal. Three novel molecules (idarucizumab, andexanet, and PER977) may provide the most effective and safest way of reversal. These agents are currently in premarketing studies.
['Crowther|Mark|M|', 'Crowther|Mark A|MA|']
D000284:Administration, Oral D000818:Animals D061067:Antibodies, Monoclonal, Humanized D000925:Anticoagulants D000931:Antidotes D001120:Arginine D001777:Blood Coagulation D003029:Coagulants D006470:Hemorrhage D006801:Humans D010879:Piperazines D018570:Risk Assessment D012307:Risk Factors D016896:Treatment Outcome
anticoagulants dabigatran rivaroxaban apixaban prothrombin complex concentrate factor VIIa hemorrhage