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Review
. 2016 Feb 17:12:35-44.
doi: 10.2147/VHRM.S89130. eCollection 2016.

Reversing anticoagulant effects of novel oral anticoagulants: role of ciraparantag, andexanet alfa, and idarucizumab

Tiffany Y Hu  1 , Vaibhav R Vaidya  2 , Samuel J Asirvatham  3
Affiliations
Review

Reversing anticoagulant effects of novel oral anticoagulants: role of ciraparantag, andexanet alfa, and idarucizumab

Tiffany Y Hu et al. Vasc Health Risk Manag. .

Abstract

Novel oral anticoagulants (NOACs) are increasingly used in clinical practice, but lack of commercially available reversal agents is a major barrier for mainstream use of these therapies. Specific antidotes to NOACs are under development. Idarucizumab (aDabi-Fab, BI 655075) is a novel humanized mouse monoclonal antibody that binds dabigatran and reverses its anticoagulant effect. In a recent Phase III study (Reversal Effects of Idarucizumab on Active Dabigatran), a 5 g intravenous infusion of idarucizumab resulted in the normalization of dilute thrombin time in 98% and 93% of the two groups studied, with normalization of ecarin-clotting time in 89% and 88% patients. Two other antidotes, andexanet alfa (PRT064445) and ciraparantag (PER977) are also under development for reversal of NOACs. In this review, we discuss commonly encountered management issues with NOACs such as periprocedural management, laboratory monitoring of anticoagulation, and management of bleeding. We review currently available data regarding specific antidotes to NOACs with respect to pharmacology and clinical trials.

Keywords: dabigatran; idarucizumab; novel oral anticoagulant; reversal.

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Figures

Figure 1
Figure 1
Coagulation cascade depicting site of action of anticoagulants and reversal agents. Notes: Dark gray: Idarucizumab – potential reversal agent for direct thrombin inhibitor (dabigatran). Light gray: Perosphere – potential reversal agents for drugs in dashed box. White: Andexanet alfa – potential reversal agent for drugs in solid box. Abbreviation: LMWH, low molecular weight heparin.
See this image and copyright information in PMC

References

    1. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–1151. - PubMed
    1. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–992. - PubMed
    1. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–891. - PubMed
    1. Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e44S–e88S. - PMC - PubMed
    1. Fanola CL. Current and emerging strategies in the management of venous thromboembolism: benefit-risk assessment of dabigatran. Vasc Health Risk Manag. 2015;11:271–282. - PMC - PubMed

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