An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants
Non-vitamin K antagonist oral anticoagulants (NOACs) include thrombin inhibitor dabigatran and coagulation factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and betrixaban. NOACs have several benefits over warfarin, including faster time to the achieve effect, rapid onset of action, fewer docume...
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doaj-21774358d9dc47f587eebf253471a2af2021-07-02T07:45:52ZengHindawi LimitedAdvances in Hematology1687-91041687-91122020-01-01202010.1155/2020/76361047636104An Update on the Reversal of Non-Vitamin K Antagonist Oral AnticoagulantsMark Terence P. Mujer0Manoj P. Rai1Varunsiri Atti2Ian Limuel Dimaandal3Abigail S. Chan4Shiva Shrotriya5Krishna Gundabolu6Prajwal Dhakal7Department of Medicine, Michigan State University, East Lansing, MI, USADepartment of Medicine, Michigan State University, East Lansing, MI, USADepartment of Medicine, Michigan State University, East Lansing, MI, USADepartment of Internal Medicine, University of Connecticut, Farmington, CT, USADepartment of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USADepartment of Medicine, Michigan State University, East Lansing, MI, USADivision of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USADivision of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USANon-vitamin K antagonist oral anticoagulants (NOACs) include thrombin inhibitor dabigatran and coagulation factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and betrixaban. NOACs have several benefits over warfarin, including faster time to the achieve effect, rapid onset of action, fewer documented food and drug interactions, lack of need for routine INR monitoring, and improved patient satisfaction. Local hemostatic measures, supportive care, and withholding the next NOAC dose are usually sufficient to achieve hemostasis among patients presenting with minor bleeding. The administration of reversal agents should be considered in patients on NOAC's with major bleeding manifestations (life-threatening bleeding, or major uncontrolled bleeding), or those who require rapid anticoagulant reversal for an emergent surgical procedure. The Food and Drug Administration (FDA) has approved two reversal agents for NOACs: idarucizumab for dabigatran and andexanet alfa for apixaban and rivaroxaban. The American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS) have released an updated guideline for the management of patients with atrial fibrillation that provides indications for the use of these reversal agents. In addition, the final results of the ANNEXA-4 study that evaluated which also provide and safety of andexanet alfa were recently published. Several agents are in different phases of clinical trials, and among them, ciraparantag has shown promising results. However, their higher cost and limited availability remains a concern. Here, we provide a brief review of the available reversal agents for NOACs (nonspecific and specific), recent updates on reversal strategies, lab parameters (including point-of-care tests), NOAC resumption, and agents in development.http://dx.doi.org/10.1155/2020/7636104 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mark Terence P. Mujer Manoj P. Rai Varunsiri Atti Ian Limuel Dimaandal Abigail S. Chan Shiva Shrotriya Krishna Gundabolu Prajwal Dhakal |
spellingShingle |
Mark Terence P. Mujer Manoj P. Rai Varunsiri Atti Ian Limuel Dimaandal Abigail S. Chan Shiva Shrotriya Krishna Gundabolu Prajwal Dhakal An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants Advances in Hematology |
author_facet |
Mark Terence P. Mujer Manoj P. Rai Varunsiri Atti Ian Limuel Dimaandal Abigail S. Chan Shiva Shrotriya Krishna Gundabolu Prajwal Dhakal |
author_sort |
Mark Terence P. Mujer |
title |
An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants |
title_short |
An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants |
title_full |
An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants |
title_fullStr |
An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants |
title_full_unstemmed |
An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants |
title_sort |
update on the reversal of non-vitamin k antagonist oral anticoagulants |
publisher |
Hindawi Limited |
series |
Advances in Hematology |
issn |
1687-9104 1687-9112 |
publishDate |
2020-01-01 |
description |
Non-vitamin K antagonist oral anticoagulants (NOACs) include thrombin inhibitor dabigatran and coagulation factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and betrixaban. NOACs have several benefits over warfarin, including faster time to the achieve effect, rapid onset of action, fewer documented food and drug interactions, lack of need for routine INR monitoring, and improved patient satisfaction. Local hemostatic measures, supportive care, and withholding the next NOAC dose are usually sufficient to achieve hemostasis among patients presenting with minor bleeding. The administration of reversal agents should be considered in patients on NOAC's with major bleeding manifestations (life-threatening bleeding, or major uncontrolled bleeding), or those who require rapid anticoagulant reversal for an emergent surgical procedure. The Food and Drug Administration (FDA) has approved two reversal agents for NOACs: idarucizumab for dabigatran and andexanet alfa for apixaban and rivaroxaban. The American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS) have released an updated guideline for the management of patients with atrial fibrillation that provides indications for the use of these reversal agents. In addition, the final results of the ANNEXA-4 study that evaluated which also provide and safety of andexanet alfa were recently published. Several agents are in different phases of clinical trials, and among them, ciraparantag has shown promising results. However, their higher cost and limited availability remains a concern. Here, we provide a brief review of the available reversal agents for NOACs (nonspecific and specific), recent updates on reversal strategies, lab parameters (including point-of-care tests), NOAC resumption, and agents in development. |
url |
http://dx.doi.org/10.1155/2020/7636104 |
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