The direct oral anticoagulants (DOACs) (apixaban, rivaroxaban, betrixaban, edoxaban
and dabigatran) have gradually replaced vitamin K antagonists (VKAs) as the mainstay
anticoagulation therapy. However, lack of specific reversal agents has been consistently
raised as a concern since the introduction of the DOACs. Major bleeding and invasive
procedures are common clinical settings where DOAC reversal may be required; further
a high frequency of co-morbid conditions makes it likely that patients treated with
DOACs will require such interruptions of their therapy. Currently only idarucizumab
(Praxbind, Boehringer Ingelheim) and andexanet alfa (Andexxa, Portola Phamaceuticals)
are approved by regulatory agents as specific DOAC reversal agents [
[1]
,
- Idaruczumab prescribing information
https://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/0761025Orig1000TOC.cfm
Date: 2019
Date accessed: June 8, 2019
[2]
]. Non-specific prohemostatic agents such as prothrombin complex concentrate (PCC)
(multiple brands) and activated prothrombin complex (APCC) (FEIBA [anti-inhibitor
coagulant complex], TAKEDA Pharmaceutical Company) have also been widely used “off-label”
for DOAC reversal [
- Andexanet alfa prescribing information
https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/andexxa-coagulation-factor-xa-recombinant-inactivated-zhzo
Date: 2019
Date accessed: June 8, 2019
3
,
4
,
- Prothrombin complex concentrate prescribing information
https://www.fda.gov/vaccines-blood-biologics/approved-blood-products/kcentra-prothrombin-complex-concentrate-human
Date: 2019
Date accessed: June 8, 2019
5
].- Activated prothrombin complex prescribing information
https://www.fda.gov/vaccines-blood-biologics/approved-blood-products/feiba-nf-anti-inhibitor-coagulant-complex
Date: 2019
Date accessed: June 8, 2019
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Article info
Publication history
Published online: July 22, 2019
Accepted:
July 13,
2019
Received:
July 12,
2019
Identification
Copyright
© 2019 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
