Reversing anticoagulant effects of novel oral anticoagulants: Role of ciraparantag, andexanetalfa, and idarucizumab

Tiffany Y. Hu, Vaibhav R. Vaidya, Samuel J Asirvatham

Research output: Contribution to journalArticle

69 Scopus citations

Abstract

Novel oral anticoagulants (NOACs) are increasingly used in clinical practice, but lack of commercially available reversal agents is a major barrier for mainstream use of these therapies. Specific antidotes to NOACs are under development. Idarucizumab (aDabi-Fab, BI 655075) is a novel humanized mouse monoclonal antibody that binds dabigatran and reverses its anticoagulant effect. In a recent Phase III study (Reversal Effects of Idarucizumab on Active Dabigatran), a 5 g intravenous infusion of idarucizumab resulted in the normalization of dilute thrombin time in 98% and 93% of the two groups studied, with normalization of ecarin-clotting time in 89% and 88% patients. Two other antidotes, andexanet alfa (PRT064445) and ciraparantag (PER977) are also under development for reversal of NOACs. In this review, we discuss commonly encountered management issues with NOACs such as periprocedural management, laboratory monitoring of anticoagulation, and management of bleeding. We review currently available data regarding specific antidotes to NOACs with respect to pharmacology and clinical trials.

Original languageEnglish (US)
Pages (from-to)35-44
Number of pages10
JournalVascular Health and Risk Management
Volume12
DOIs
StatePublished - Feb 17 2016

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Keywords

  • Dabigatran
  • Idarucizumab
  • Novel oral anticoagulant
  • Reversal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)
  • Public Health, Environmental and Occupational Health
  • Hematology
  • Endocrinology, Diabetes and Metabolism

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