Reversal of anticoagulant effects of edoxaban, an oral, direct factor Xa inhibitor, with haemostatic agents

Fukuda, Toshio; Honda, Yuko; Kamisato, Chikako; Morishima, Yasuo; Shibano, Toshiro

doi:10.1160/th11-09-0668

Cited by 125 publications

(84 citation statements)

References 29 publications

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“…Current studies indicate that prothrombin complex concentrate, activated prothrombin complex concentrate, and recombinant factor VIIa as well as PER977 are all promising for reversal of anticoagulation with edoxaban (36,37). A novel recombinant protein (r-Antidote, PRT064445) that binds to factor Xa inhibitors and reverses the anticoagulant effect also has potential for factor Xa inhibitor reversal (38).…”

Section: Edoxabanmentioning

confidence: 99%

Use of novel oral anticoagulant agents in venous thromboembolism

Madan¹,

Shah²,

Dale³

et al. 2016

Cardiovasc. Diagn. Ther.

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New oral anticoagulants (NOAC) serve as alternatives for patients currently using warfarin for the prevention and treatment of venous thromboembolic (VTE) disease. This article provides a brief summary of the clinical use of these drugs as well as a review of the landmark clinical trials which evaluated described their safety and efficacy. As more data becomes available, a fundamental understanding of these medications will be vital to cardiovascular practitioners managing patients with VTE.

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Section: Edoxabanmentioning

confidence: 99%

Use of novel oral anticoagulant agents in venous thromboembolism

Madan¹,

Shah²,

Dale³

et al. 2016

Cardiovasc. Diagn. Ther.

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“…In contrast to dabigatran, the PT is more generally sensitive to rivaroxaban than the aPTT, although differential reagent sensitivity is observed. 4,19,24,25,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69] All TT and ecarin-based assays (i.e., standard TT, dTT, HTI, ECT, and ECA) are insensitive to rivaroxaban. 24,35,55,61,63 The PICT assay was also reported as sensitive, although this assay may require some major degree of optimization.…”

Section: Rivaroxabanmentioning

confidence: 99%

“…4,19,24,25,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69] All TT and ecarin-based assays (i.e., standard TT, dTT, HTI, ECT, and ECA) are insensitive to rivaroxaban. 24,35,55,61,63 The PICT assay was also reported as sensitive, although this assay may require some major degree of optimization. 35,56,61,70,71 In general, most publications recommended the use of an anti-Xa assay using a specific rivaroxaban standard, as these assays showed greatest utility.…”

Section: Rivaroxabanmentioning

confidence: 99%

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Laboratory Testing in the Era of Direct or Non–Vitamin K Antagonist Oral Anticoagulants: A Practical Guide to Measuring Their Activity and Avoiding Diagnostic Errors

Favaloro

Lippi

2015

Semin Thromb Hemost

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A new generation of antithrombotic agents has recently emerged. These provide direct inhibition of either thrombin (factor IIa [FIIa]) or FXa, and are increasingly replacing the classical anticoagulants (heparin and coumarins such as warfarin) in clinical practice for a variety of conditions. These agents have been designated several acronyms, including NOACs, DOACs, and TSOACs, respectively, referring to ew (ovel; on?vitamin K antagonist) ral ntioagulant, irect ral ntioagulant, and arget-pecific ral ntioagulant, and currently include dabigatran (FIIa inhibitor), and rivaroxaban, apixaban, edoxaban, and betrixaban (FXa inhibitors). The pervading mantra that NOACs do not require laboratory monitoring is countered by ongoing recognition that laboratory testing for drug effects is needed in many situations. Moreover, since these agents ?do not require? laboratory monitoring, some clinicians inappropriately take this to mean that they do not affect hemostasis tests. This review aims to briefly review the laboratory studies that have evaluated the NOACs against a wide range of laboratory assays to assess utility for qualitative or quantitative measurements of these drugs, as well as interferences that may cause misdiagnosis of hemostatic defects. Point of care testing, including use of alternate samples such as urine and serum, is also under development but is not covered extensively in this review. The main aims of this article are to provide practical guidance to general laboratory testing for NOACs, as well as to help avoid diagnostic errors associated with hemostasis testing performed on samples from treated patients, as these currently comprise major challenges to hemostasis laboratories in the era of the NOACs.

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“…[26][27][28][29][30] Findings have been more mixed in reversing dabigatran. PCCs and aPCCs were partially or fully effective in reversing dabigatran in most animal studies.…”

Section: Do We Really Need Antidotes For Noacs?mentioning

confidence: 99%

Reversing targeted oral anticoagulants

Hoffman

Monroe

2014

Hematology

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Dabigatran, rivaroxaban, and apixaban are orally active anticoagulants that are approved in many countries. Dabigatran inhibits thrombin, whereas rivaroxaban and apixaban are factor Xa inhibitors. In clinical trials, these novel oral anticoagulants were at least as effective as warfarin for preventing stroke in patients with atrial fibrillation, but with a lower rate of serious bleeding. However, the lack of true antidotes for these agents has caused concern when patients suffer life-threatening bleeding or trauma or require emergent invasive procedures. True antidotes are under development for all of these agents. In the meantime, activated and nonactivated prothrombin complex concentrates have been used as reversal agents. Factor VIIa may also be effective for reversal of the factor Xa inhibitors. Reversal of novel oral anticoagulants by these hemostatic agents has not been studied in bleeding human patients, so their true efficacy and appropriate dosing are not known. Learning Objective• To understand the currently available options for enhancing hemostasis in a patient on one of the targeted oral anticoagulants

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Reversal of anticoagulant effects of edoxaban, an oral, direct factor Xa inhibitor, with haemostatic agents

Cited by 125 publications

References 29 publications

Use of novel oral anticoagulant agents in venous thromboembolism

Use of novel oral anticoagulant agents in venous thromboembolism

Laboratory Testing in the Era of Direct or Non–Vitamin K Antagonist Oral Anticoagulants: A Practical Guide to Measuring Their Activity and Avoiding Diagnostic Errors

Reversing targeted oral anticoagulants

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