‡ Andexanet use is approved for use in severe uncontrolled or life-threatening bleeding associated with apixaban and rivaroxaban, and is not approved for use in severe uncontrolled or life-threatening bleeding associated with edoxaban and betrixaban, nor to reverse any of the oral direct factor Xa inhibitors in patients undergoing surgery or other invasive procedures. ![]() † Low dose andexanet alfa (400 mg bolus at 30 mg/min + infusion of 480 mg at 4 mg/min for 120 min) is indicated in case of time of last DOAC dose ≥ 8 h regardless of DOAC dose, or time of last DOAC dose < 8 h/unknown and apixaban dose ≤ 5 mg or rivaroxaban dose ≤ 10 mg. * High dose andexanet alfa (800 mg bolus at 30 mg/min + infusion of 960 mg at 8 mg/min for 120 min) is indicated in case of time of last DOAC dose 5 mg/unknown or rivaroxaban dose > 10 mg/unknown. 4PCC = Four-factor Prothrombin Complex Concentrate (Beriplex/Kcentra®, Octaplex®, Prothromplex® APCC = Activated Prothrombin Complex Concentrate, also called anti-inhibitor coagulant complex or factor eight bypassing agent (FEIBA®) DOAC = direct oral anticoagulant g = grams h = hours kg = kilograms mg = milligrams U = units unk = unknown. ![]() Specific reversal agents are recommended for use in clinical situations within their licensed indications (i.e.: reversal of DOACs in patients with severe uncontrolled or life-threatening bleeding or in need of emergency surgery or other invasive procedures), while non-specific reversal agents may be used when specific antidotes are not available or indicated.įlowchart of the use of reversal agents for DOACs. New investigational antidotes such as ciraparantag and VMX-C001 offer an alternative to andexanet alfa in reversing the anticoagulant activity of direct oral factor Xa inhibitors, but more clinical data are needed before they could be licensed for use. ![]() Specific (idarucizumab for dabigatran and andexanet alfa for direct factor Xa inhibitors) and non-specific (prothrombin complex concentrates) reversal agents are effective in neutralizing the anticoagulant effect of DOACs. Our objective is to describe currently available reversal agents for direct oral anticoagulants (DOACs), their target population, the available clinical practice recommendations and future directions.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |