Bleeding and antidotes in new oral anticoagulants.
Author(s): Majeed A(1), Schulman S.
Affiliation(s): Author information:
(1)Hematology Center, Karolinska University Hospital and Karolinska Institute,
Stockholm, Sweden.
Publication date & source: 2013, Best Pract Res Clin Haematol. , 26(2):191-202
In the past decade, several new oral anticoagulants (NOACs) have been studied and
approved for the prophylaxis and treatment of arterial and venous
thromboembolism. These agents were shown to be as effective as or better than
warfarin and resulted in comparable or lower bleeding rates than warfarin.
Specific antidotes for the reversal of the anticoagulant effect of these drugs,
such as monoclonal antibodies against the direct thrombin inhibitor dabigatran or
recombinant Xa-analog in the case of factor Xa inhibitors, are still being
investigated in early clinical trials. In certain situations, as in case of
emergency surgery or life-threatening major bleeding, a rapid reversal strategy
is needed. Several non-specific prohemostatic agents or coagulation factor
concentrates have been suggested as potential candidates for the reversal of
NOACs, but the evidence supporting these agents was mainly derived from small
animal studies, or is based on partial or complete correction of laboratory
parameters in healthy volunteers treated with these agents. Activated prothrombin
complex concentrate seems promising for the reversal of dabigatran, while
non-activated prothrombin complex concentrates have potential for the reversal of
anti-factor Xa. The risk of thromboembolic complications requires careful
evaluation. In this article, the evidence- or the lack of it - supporting the use
of the different prohemostatic agents for the management of bleeding and for
reversal of the different classes of NOACs is discussed.
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