Since their relatively recent introduction, a major concern over NOAC use has been the lack of available reversal agents akin to vitamin K or fresh frozen plasma used to reverse anticoagulation effect of warfarin.
Fortunately, there are currently three potential NOAC reversal agents on breakthrough or fast-track status at the FDA, facilitating their rapid approval based on phase III trials:
- Idarucizumab, a humanized mouse antibody fragment, or Fab, targeted specifically for reversal of dabigatran
- Andexanet alfa, a class-specific antidote for reversal of direct factor Xa inhibitors (apixaban, rivaroxaban, edoxaban), as well as an indirect factor Xa inhibitor, enoxaparin
- Ciraparantag (PER977), a synthetic water-soluble compound that reverses direct thrombin (dabigatran), direct factor Xa (apixaban, rivaroxaban, edoxaban), and indirect factor Xa inhibitors (enoxaparin) (1).
So stay tuned…Help may be on the way!
1. Ansell JE. Universal, class-specific, and drug-specific reversal agents for the new oral anticoagulants. J Thromb Thrombolysis 2016;41:248-52. https://www.ncbi.nlm.nih.gov/pubmed/26449414
Contributed by William L. Hwang, MD, Mass General Hospital, Boston, MA.