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

Authors Hu T, Vaidya V, Asirvatham S

Received 3 September 2015

Accepted for publication 2 November 2015

Published 17 February 2016 Volume 2016:12 Pages 35—44

DOI https://doi.org/10.2147/VHRM.S89130

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amudha Kadirvelu

Peer reviewer comments 2

Editor who approved publication: Professor Daniel Duprez


Video abstract presented by Vaidhav R Vaidya and Tiffany Y Hu.

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Tiffany Y Hu,1 Vaibhav R Vaidya,2 Samuel J Asirvatham2,3

1Mayo Medical School, 2Division of Cardiovascular Diseases, Department of Internal Medicine, 3Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA

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: novel oral anticoagulant, dabigatran, idarucizumab, reversal

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