Description
Title: An Update on the Reversal of Oral Anticoagulants that are Not Vitamin K Antagonists
Abstract: Dabigatran, a thrombin inhibitor, and the coagulation factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and betrixaban are examples of non-vitamin K antagonist oral anticoagulants (NOACs). In comparison to warfarin, NOACs offer a number of advantages, including a quicker time to effect, a quicker onset of action, fewer documented food and drug interactions, a lack of the need for frequent INR monitoring, and higher patient satisfaction. When patients with minor bleeding first present, local hemostatic interventions, supportive care, and delaying the next NOAC dose are typically enough to achieve hemostasis. Patients on NOACs who have major bleeding manifestations (such as life-threatening bleeding or significant uncontrolled bleeding) or who need quick anticoagulant reversal for an urgent surgical procedure should take the administration of reversal agents into consideration. Two reversal agents for NOACs have received FDA approval: andexanet alfa for apixaban and rivaroxaban, and idarucizumab for dabigatran. +e An updated guideline for the management of patients with atrial fibrillation has been released by the American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS), and it provides indications for the use of these reversal agents. Additionally, the ANNEXA-4 study’s final findings, which assessed the effectiveness and safety of andexanet alfa, were just released. Several medications are undergoing various stages of clinical trials, and ciraparantag is one of them. Their higher price and restricted availability, however, continue to be an issue. The available reversal agents for NOACs (both nonspecific and specific) are briefly reviewed here, along with recent advancements in reversal techniques, lab parameters (including point-of-care tests), NOAC resumption, and agents in development.
Paper Quality: SCOPUS / Web of Science Level Research Paper
Subject: Medicine
Sub Category: Hematology
Writer Experience: 20+ Years
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