Reversal Agents

Managing Reversal Of Direct Oral Anticoagulants In Emergency Situations

A Prospective Cohort Study Of Idarucizumab For Reversal

Idarucizumab: The Antidote For Reversal Of Dabigatran

Videos Dabigatran Reversal Andexanet Alfa Ciraparantag Guidelines

About

Direct oral anticoagulants (DOACs) are increasingly used for prevention and treatment of venous thromboembolism and for prevention of stroke in patients with non-valvular atrial fibrillation.
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Direct oral anticoagulants (DOACs) are increasingly used for prevention and treatment of venous thromboembolism and for prevention of stroke in patients with non-valvular atrial fibrillation.

Anticoagulant reversal should only be considered with life-threatening bleeds, with bleeds that fail to respond to usual measures, and in patients requiring urgent surgery.

Idarucizumab is licensed for dabigatran reversal. The Factor Xa inhibitor andexanet alfa has recently been licensed in the US for reversal of rivaroxaban, apixaban and edoxaban.
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Videos

Idarucizumab for Dabigatran Reversal - Full Cohort Analysis - Animated Video

06 April 2018
Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation

20 July 2017
RE-CIRCUIT - Uninterrupted Dabigatran vs Warfarin for Ablation in AF

09 June 2017
RE-VERSE AD

13 April 2017

Reversal Agents - New This Month

Specific antidotes for bleeding associated with direct oral anticoagulants

Burnett A, Siegal D, Crowther M, et al

BMJ 2017;357:j2216
Reversal strategies for non-vitamin K antagonist oral anticoagulants: a critical appraisal of available evidence and recommendations for clinical management

Alexander Niessner, Juan Tamargo, João Morais, et al

Eur Heart J (2017) 38 (22): 1710-1716.
Idarucizumab for Dabigatran Reversal — Full Cohort Analysis

Charles V. Pollack, Paul A. Reilly, Joanne van Ryn, et al

Reversal Agents - Idarucizumab for Dabigatran Reversal

Idarucizumab, a Specific Antidote for Dabigatran: Immediate, Complete and Sustained Reversal of Dabigatran Induced Anticoagulation in Elderly and Renally Impaired Subjects

Stephan Glund, J. Stangier, Michael Schmohl, et al

Blood 2014 124:344;
Idarucizumab: The Antidote for Reversal of Dabigatran

John Eikelboom, Daniel J. Quinlan, J. van Ryn, et al

Circulation. 2015;132:2412-2422.
Design and rationale for RE-VERSE AD: A phase 3 study of idarucizumab, a specific reversal agent for dabigatran

Charles V. Pollack, Paul A. Reilly, Richard A. Bernstein, et al

Thromb Haemost 2015; 114: 198–205
A randomised study in healthy volunteers to investigate the safety, tolerability and pharmacokinetics of idarucizumab, a specific antidote to dabigatran

Stephan Glund, V. Moschetti, Stephen Norris, et al

Thromb Haemost 2015; 113: 943–951.

Reversal Agents - Andexanet Alfa for Factor Xa Inhibitors

A Phase 2 Randomized, Double-Blind, Placebo-Controlled Trial Demonstrating Reversal Of Rivaroxaban-Induced Anticoagulation In Healthy Subjects By Andexanet Alfa (PRT064445), An Antidote For Fxa Inhibitors

Mark Crowther, Mathur Vandana, Kitt Michael, et al

Blood 2013 122:3636;
A Phase 2 Randomized, Double-Blind, Placebo-Controlled Trial Demonstrating Reversal of Edoxaban-Induced Anticoagulation in Healthy Subjects By Andexanet Alfa (PRT064445), a Universal Antidote for Factor Xa (fXa) Inhibitors

Mark Crowther, Gallia G. Levy, Genmin Lu, et al

Blood 2014 124:4269;
Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors

Stuart J. Connolly, Truman J. Milling, John Eikelboom, et al

N Engl J Med. 2016 Sep 22;375(12):1131-41.

Reversal Agents - Ciraparantag for Factor Xa Inhibitors

Ciraparantag safely and completely reverses the anticoagulant effects of low molecular weight heparin

Jack E. Ansell, Bryan E. Laulicht, Sasha H. Bakhru, et al

Thromb Res. 2016 Oct;146:113-118.
Single-dose ciraparantag safely and completely reverses anticoagulant effects of edoxaban

Jack E. Ansell, Sasha H. Bakhru, Bryan E. Laulicht, et al

Thromb Haemost. 2017 Jan 26;117(2):238-245.

Reversal Agents - Guidelines/expert recommendations

Reversal of Direct Oral Anticoagulants: Current Status and Future Directions

Jeffrey I. Weitz

Semin Respir Crit Care Med. 2017 Feb;38(1):40-50.
Managing reversal of direct oral anticoagulants in emergency situations

Walter Ageno, Harry R. Buller, A. Falanga, et al

Thromb Haemost. 2016 Nov 30;116(6):1003-1010.
When and how to use antidotes for the reversal of direct oral anticoagulants: guidance from the SSC of the ISTH

Jerrold H. Levy, Walter Ageno, N. C. Chan, et al

J Thromb Haemost. 2016 Mar;14(3):623-7.
Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Amish N. Raval, Joaquin E. Cigarroa, Mina K. Chung, et al

Circulation. 2017;135:e604-e633

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