Novel antidotes for target specific oral anticoagulants

Das, Arundhati; Liu, Delong

doi:10.1186/s40164-015-0020-3

Cited by 28 publications

(24 citation statements)

References 33 publications

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“…This was identified using the dilute thrombin time or ecarin clotting time at a central laboratory. The median maximum percentage reversal was 100% (32).…”

Section: Reversal Agentsmentioning

confidence: 94%

Novel anticoagulants – an update on the latest developments and management for clinicians treating patients on these drugs

Green

Mendes

Valk

et al. 2016

J Oral Pathology Medicine

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There are several novel anticoagulant agents that are being increasingly used as an alternative to warfarin, with these drugs being reported to be at least as effective if not better. Their increased use means that oral care clinicians should have a sound understanding of the mechanism of action, pharmacology, reversal strategies and management of bleeding in patients taking these drugs. Surprisingly, there is little published in the current literature specific to professionals involved in oral health care. In this review, we provide an overview of these drugs and discuss the management of patients who need an oral procedure based on currently available literature and clinical trials.

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“…This was identified using the dilute thrombin time or ecarin clotting time at a central laboratory. The median maximum percentage reversal was 100% (32).…”

Section: Reversal Agentsmentioning

confidence: 94%

Novel anticoagulants – an update on the latest developments and management for clinicians treating patients on these drugs

Green

Mendes

Valk

et al. 2016

J Oral Pathology Medicine

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“…However, a new class of oral, non-vitamin K anticoagulants which do not require much monitoring or dose adjustment include dabigatran, rivaroxaban, edoxaban and apixaban. Again, novel molecules considered to be safest and most efficacious such as idarucizumab, PER977 and andexanet still remain in premarketing studies [44,45]. Intravenous lipid emulsions (ILEs) are another example of wide spectrum antidotes utilized in cases of cardiotoxicity [46].…”

Section: Universal/general Antidotesmentioning

confidence: 99%

An Appraisal of Antidotes’ Effectiveness: Evidence of the Use of Phyto-Antidotes and Biotechnological Advancements

et al. 2020

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Poisoning is the greatest source of avoidable death in the world and can result from industrial exhausts, incessant bush burning, drug overdose, accidental toxication or snake envenomation. Since the advent of Albert Calmette’s cobra venom antidote, efforts have been geared towards antidotes development for various poisons to date. While there are resources and facilities to tackle poisoning in urban areas, rural areas and developing countries are challenged with poisoning management due to either the absence of or inadequate facilities and this has paved the way for phyto-antidotes, some of which have been scientifically validated. This review presents the scope of antidotes’ effectiveness in different experimental models and biotechnological advancements in antidote research for future applications. While pockets of evidence of the effectiveness of antidotes exist in vitro and in vivo with ample biotechnological developments, the utilization of analytic assays on existing and newly developed antidotes that have surpassed the proof of concept stage, as well as the inclusion of antidote’s short and long-term risk assessment report, will help in providing the required scientific evidence(s) prior to regulatory authorities’ approval.

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“…While ciraparantag bonds with argatroban, this interaction does not interfere with the binding of argatroban to FIIa. 52 Ciraparantag exhibits no binding to serum albumin or other plasma coagulation factors and, therefore, has no procoagulant effect. Ciraparantag has progressed through the early stages of clinical development and is now being investigated in Phase II human trials (Table 5).…”

Section: Ciraparantagmentioning

confidence: 99%

“…Ciraparantag has progressed through the early stages of clinical development and is now being investigated in Phase II human trials (Table 5). 52,53 S40 Am J HeAltH-SySt PHArm | Volume 73 | number 10 | may 15, 2016 | suPPl 2 raparantag 5, 15, 25, 50, 100, 200, or 300 mg or an i.v. placebo.…”

Section: Ciraparantagmentioning

confidence: 99%

Reversal agents for use with direct and indirect anticoagulants

Smythe

Trujillo

Fanikos

2016

American Journal of Health-System Pharmacy

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Purpose. The properties of three oral anticoagulant-specific reversal agents are reviewed, and guidance is presented to assist pharmacists in planning for the agents' introduction to the market.Summary. Idarucizumab, which received Food and Drug administration approval in october 2015, is a humanized monoclonal antibody fragment that immediately neutralizes the anticoagulant effect of dabigatran, as evidenced by reduced unbound dabigatran concentrations and normalized coagulation tests. Preliminary Phase III trial results demonstrated a median maximum reversal of 100%, a median time to bleeding cessation of 11.4 hours, and normal intraoperative hemostasis in 92% of patients requiring anticoagulation reversal before an urgent procedure. andexanet alfa is a factor Xa (FXa) decoy that binds to direct and indirect FXa inhibitors. In Phase III trials in healthy volunteers, andexanet alfa reduced anti-FXa activity by more than 90%, reduced the concentration of unbound direct FXa inhibitor, and inhibited thrombin generation. Ciraparantag is a reversal agent under development for reversal of anticoagulation with direct and indirect FXa inhibitors and certain factor IIa inhibitors; it exerts its effect through hydrogen bonding. Concerns for thromboembolic events directly related to administration of idarucizumab, andexanet alfa, or ciraparantag have not arisen. Pharmacists need to begin preparing for the introduction of these specific reversal agents through protocol development and provider education; in addition, pharmacy departments need to plan for procurement and storage. The specific reversal agents should be incorporated into antithrombotic stewardship or other clinical pharmacy programs for surveillance.Conclusion. as agents that provide rapid reversal of direct oral anticoagulant activity become available, advance planning will help hospitals to optimize their use.Am J Health-Syst Pharm. 2016; 73(suppl 2):s27-48

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Novel antidotes for target specific oral anticoagulants

Cited by 28 publications

References 33 publications

Novel anticoagulants – an update on the latest developments and management for clinicians treating patients on these drugs

Novel anticoagulants – an update on the latest developments and management for clinicians treating patients on these drugs

An Appraisal of Antidotes’ Effectiveness: Evidence of the Use of Phyto-Antidotes and Biotechnological Advancements

Reversal agents for use with direct and indirect anticoagulants

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