Present Knowledge on Direct Oral Anticoagulant and Novel Oral Anti Coagulants and Their Specific Antidotes: A Comprehensive Review Article

Biswas, Sunil Kumar; Bahar, Yasemin; Bahar, Abdul Rasheed; Safiriyu, Israel; Mathai, Sheetal Vasundara; Hajra, Adrija; Gupta, Rahul; Aronow, Wilbert S.

doi:10.1016/j.cpcardiol.2022.101483

Cited by 9 publications

(6 citation statements)

References 60 publications

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“…Idarucizumab is a humanized monoclonal antibody fragment with a high affinity for dabigatran 44 and can be considered the best therapeutic option for patients taking the direct thrombin inhibitor dabigatran who present with ICH. The prospective single-arm RE-VERSE AD study (Reversal Effects of Idarucizumab on Active Dabigatran) found that in emergency situations, 5 g of intravenous idarucizumab can be administered safely to rapidly reverse the anticoagulant effect of dabigatran as assessed by coagulation assays.…”

Section: Direct Thrombin Inhibitorsmentioning

confidence: 99%

Code ICH: A Call to Action

Li,

Yakhkind,

Alexandrov

et al. 2024

Stroke

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Intracerebral hemorrhage is the most serious type of stroke, leading to high rates of severe disability and mortality. Hematoma expansion is an independent predictor of poor functional outcome and is a compelling target for intervention. For decades, randomized trials aimed at decreasing hematoma expansion through single interventions have failed to meet their primary outcomes of statistically significant improvement in neurological outcomes. A wide range of evidence suggests that ultra-early bundled care, with multiple simultaneous interventions in the acute phase, offers the best hope of limiting hematoma expansion and improving functional recovery. Patients with intracerebral hemorrhage who fail to receive early aggressive care have worse outcomes, suggesting that an important treatment opportunity exists. This consensus statement puts forth a call to action to establish a protocol for Code ICH, similar to current strategies used for the management of acute ischemic stroke, through which early intervention, bundled care, and time-based metrics have substantially improved neurological outcomes. Based on current evidence, we advocate for the widespread adoption of an early bundle of care for patients with intracerebral hemorrhage focused on time-based metrics for blood pressure control and emergency reversal of anticoagulation, with the goal of optimizing the benefit of these already widely used interventions. We hope Code ICH will endure as a structural platform for continued innovation, standardization of best practices, and ongoing quality improvement for years to come.

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Section: Direct Thrombin Inhibitorsmentioning

confidence: 99%

Code ICH: A Call to Action

Li,

Yakhkind,

Alexandrov

et al. 2024

Stroke

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“…Since 2010, when the first DOAC became clinically available in the USA, this class of drugs has been preferred because of its advantages over coumarin derivatives, including ease of use, a wider therapeutic range with less strict monitoring requirements, fewer drug interactions, and a favorable pharmacological profile with a fixed dose ( Biswas et al, 2023 ). The pharmacokinetic and pharmacodynamic properties of DOACs and coumarin derivatives are summarized in Table 1 .…”

Section: Anticoagulation Indications and Optionsmentioning

confidence: 99%

“…In cases of mild or minor bleeding, delayed or temporary drug discontinuation combined with local hemostatic therapy may be sufficient. If major bleeding occurs, additional measures must be considered, such as administering activated charcoal within 2 h after ingestion, blood derivatives, tranexamic acid, platelet concentration if the platelet count is < 60,000/dL, desmopressin for coagulopathy, hemodialysis, recombinant factor VIIa, and hemodynamic support ( Ferri and Corsini, 2015 ; Romano et al, 2020 ; Biswas et al, 2023 ). However, few studies and clinical trials have demonstrated the reversal effects of these efforts in patients with DOAC-associated bleeding ( Butler et al, 1993 ; Wolzt et al, 2004 ; Pragst et al, 2012 ; Shih and Crowther, 2016 ; Tummala et al, 2016 ; Levy et al, 2018 ; Hartig et al, 2021 ).…”

Section: Bleeding Management With Doacsmentioning

confidence: 99%

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Thromboembolic prevention in athletes: management of anticoagulation in sports players affected by atrial fibrillation

Minardi,

Sciarra,

Robles

et al. 2024

Front. Pharmacol.

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Atrial fibrillation (AF) is a common cardiac arrhythmia that poses a significant risk of stroke and thromboembolic events. Anticoagulation therapy is essential for preventing stroke in patients with AF. An increasing number of people of all ages, including cardiac patients, approach physical activity as both a leisure-time exercise and a competitive sport. Therefore, patients at risk of AF are increasingly allowed to practice sports activities. Management of oral anticoagulant therapy (OAT) in these patients is extremely challenging because of the need to balance the risks and benefits of medications, considering both hemorrhagic (in case of trauma) and ischemic complications when the drugs are avoided. Official recommendations are limited for these patients and forbid sports that increase the risk of trauma and consequent bleeding in most cases. These recommendations are strongly influenced by the “traditional” management of OAT, which mainly involves coumarin derivatives. Non-vitamin K antagonist direct oral anticoagulants (DOACs), with their more favorable pharmacokinetic–pharmacodynamic profile than that of coumarin derivatives, may represent an opportunity to modify the approach to sports activity in patients with AF and indications for OAT. This study aimed to review the use of anticoagulants in athletes with AF, highlight their efficacy and safety, and provide practical considerations regarding their management.

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“…Moreover, severe cases require highly invasive interventions such as coronary artery bypass percutaneous transluminal, coronary angioplasty, grafting, and stenting. [ 16 ] However, studies have shown that stent implantation can cause stimulating reactions and the formation of blood clots. [ 17 ] Another challenge is the existence of physiological barriers with high rigidity and density that can limit the CCVD therapeutic efficacy.…”

Section: Introductionmentioning

confidence: 99%

Progress on Physical Field‐Regulated Micro/Nanomotors for Cardiovascular and Cerebrovascular Disease Treatment

et al. 2023

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Cardiovascular and cerebrovascular diseases (CCVDs) are two major vasculature‐related diseases that seriously affect public health worldwide, which can cause serious death and disability. Lack of targeting effect of the traditional CCVD treatment drugs may damage other tissues and organs, thus more specific methods are needed to solve this dilemma. Micro/nanomotors are new materials that can convert external energy into driving force for autonomous movement, which can not only enhance the penetration depth and retention rates, but also increase the contact areas with the lesion sites (such as thrombus and inflammation sites of blood vessels). Physical field‐regulated micro/nanomotors using the physical energy sources with deep tissue penetration and controllable performance, such as magnetic field, light, and ultrasound, etc. are considered as the emerging patient‐friendly and effective therapeutic tools to overcome the limitations of conventional CCVD treatments. Recent efforts have suggested that physical field‐regulated micro/nanomotors on CCVD treatments could simultaneously provide efficient therapeutic effect and intelligent control. In this review, various physical field‐driven micro/nanomotors are mainly introduced and their latest advances for CCVDs are highlighted. Last, the remaining challenges and future perspectives regarding the physical field‐regulated micro/nanomotors for CCVD treatments are discussed and outlined.

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Present Knowledge on Direct Oral Anticoagulant and Novel Oral Anti Coagulants and Their Specific Antidotes: A Comprehensive Review Article

Cited by 9 publications

References 60 publications

Code ICH: A Call to Action

Code ICH: A Call to Action

Thromboembolic prevention in athletes: management of anticoagulation in sports players affected by atrial fibrillation

Progress on Physical Field‐Regulated Micro/Nanomotors for Cardiovascular and Cerebrovascular Disease Treatment

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