New agents for DOAC reversal: a practical management review

White, Katie; Faruqi, Uzma; Cohen, Aloni

doi:10.5837/bjc.2022.001

Cited by 15 publications

(22 citation statements)

References 20 publications

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“…Such agents have therefore been typically used in an off-label fashion prior to the invention of the direct antidotes and currently when such antidotes are not clinically available. The aim is to boost factor levels, but it cannot directly inhibit the DOAC or affect factor Xa levels ( 56 ).…”

Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

“…Whilst such agents are available, guidance still suggests that they should only be administered if bleeding is life threatening into a critical organ, or not controlled with maximal supportive measures, which given DOAC short half-lives is usually enough ( 52 , 56 ). Furthermore, prior to invasive procedures, DOACs should not be reversed unless the bleeding risk associated with the procedure is sufficiently high when balanced with the risk of prothrombotic events and high costs.…”

Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

“…Furthermore, prior to invasive procedures, DOACs should not be reversed unless the bleeding risk associated with the procedure is sufficiently high when balanced with the risk of prothrombotic events and high costs. (Andexanet alfa costs £11,100/pack in the UK and $5500 per 200 mg vial in the United States, whereas Idarucizumab costs £2400 per 5 g and $3500 per 5 g kit, respectively) ( 52 , 56 , 57 ).…”

Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

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Proximal femur fractures in patients taking anti-coagulants: has anything changed?

Giannoudi

Giannoudis

2022

EFORT Open Reviews

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With an ever-ageing population, the incidence of hip fractures is increasing worldwide. Increasing age is not just associated with increasing fractures but also increasing comorbidities and polypharmacy. Consequently, a large proportion of patients requiring hip fracture surgery (HFS) are also prescribed antiplatelet and anti-coagulant medication. There remains a clinical conundrum with regards to how such medications should affect surgery, namely with regards to anaesthetic options, timing of surgery, stopping and starting the medication as well as the need for reversal agents. Herein, we present the up-to-date evidence on HFS management in patients taking blood-thinning agents and provide a summary of recommendations based on the existing literature.

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Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

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Proximal femur fractures in patients taking anti-coagulants: has anything changed?

Giannoudi

Giannoudis

2022

EFORT Open Reviews

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“…Direct oral anticoagulants can broadly be classified as factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and direct thrombin (IIa) inhibitors (dabigatran). There are two specific drugs approved for the reversal of direct oral anticoagulants: idarucizumab for reversal of dabigatran; and andexanet alfa for rivaroxaban and apixaban [ 65 ]. There is no currently approved reversal drug for edoxaban.…”

Section: Pharmacological Interventions That May Prevent or Reverse Co...mentioning

confidence: 99%

Major haemorrhage: past, present and future

et al. 2022

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Summary Major haemorrhage is a leading cause of morbidity and mortality worldwide. Successful treatment requires early recognition, planned responses, readily available resources (such as blood products) and rapid access to surgery or interventional radiology. Major haemorrhage is often accompanied by volume loss, haemodilution, acidaemia, hypothermia and coagulopathy (factor consumption and fibrinolysis). Management of major haemorrhage over the past decade has evolved to now deliver a ‘package’ of haemostatic resuscitation including: surgical or radiological control of bleeding; regular monitoring of haemostasis; advanced critical care support; and avoidance of the lethal triad of hypothermia, acidaemia and coagulopathy. Recent trial data advocate for a more personalised approach depending on the clinical scenario. Fresh frozen plasma should be given as early as possible in major trauma in a 1:1 ratio with red blood cells until the results of coagulation tests are available. Tranexamic acid is a cheap, life‐saving drug and is advocated in major trauma, postpartum haemorrhage and surgery, but not in patients with gastrointestinal bleeding. Fibrinogen levels should be maintained > 2 g.l−1 in postpartum haemorrhage and > 1.5 g.l−1 in other haemorrhage. Improving outcomes after major traumatic haemorrhage is now driving research to include extending blood‐product resuscitation into prehospital care.

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“…[45,46] If specific reversal agents for DOACs are unavailable or unapproved, as in the case of edoxaban, prothrombin complex concentrate (PCC) or activated prothrombin complex concentrate (aPCC) are often used in the event of severe bleeding or the need for emergency surgery. [45,46] APCC is more recommended for bleeding associated with dabigatran intake, while PCC is used for bleeding associated with Xa inhibitor therapy. [45] It is important to note that in cases of major bleeding, fresh frozen plasma is ineffective in patients taking DOACs.…”

Section: State Of Knowledgementioning

confidence: 99%

Oral anticoagulation – current knowlegde

Karaś

Kawałko

Bielewicz

et al. 2022

J Educ Health Sport

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Vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC) are two groups of drugs used in the prevention of thromboembolic events. Although DOACs are currently the preferred option in such prophylaxis, there are still indications for the use of VKAs. Thromboembolic episodes may occur as a result of many cardiovascular diseases, inter alia cardiac dysrhythmias. Atrial fibrillation is an arrhythmia that may be asymptomatic or manifested by chest pain, syncope, dyspnea or fatigue. Moreover, it is associated with a high risk of serious complications. An ischemic stroke or myocardial infarction can result from poorly treated AF and may sometimes be the only symptom of an arrhythmia. Therefore, the assessment of a patient's eligibility for anticoagulation therapy is an important element in the prevention of thromboembolic events. Demographic aging and the associated comorbidity may pose a clinical problem in the treatment of atrial fibrillation. The selection of an appropriate anticoagulant therapy should be individualized to the patient's needs.

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New agents for DOAC reversal: a practical management review

Cited by 15 publications

References 20 publications

Proximal femur fractures in patients taking anti-coagulants: has anything changed?

Proximal femur fractures in patients taking anti-coagulants: has anything changed?

Major haemorrhage: past, present and future

Oral anticoagulation – current knowlegde

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