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Universal, class-specific and drug-specific reversal agents for the new oral anticoagulants

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Abstract

Although there is controversy about the absolute need for a reversal agent for the new direct oral anticoagulants (DOACs), the absence of such an agent is a barrier to more widespread use of these agents. For the management of major life-threatening bleeding with the DOACs, most authorities recommend the use of four factor prothrombin complex concentrates, although the evidence to support their use in terms of improving outcomes is meager. At the present time, there are three antidotes in development and poised to enter the market. Idarucizumab is a drug-specific antidote targeted to reverse the direct thrombin inhibitor, dabigatran. Andexanet alfa is a class-specific antidote targeted to reverse the oral direct factor Xa inhibitors as well as the indirect inhibitor, enoxaparin. Ciraparantag is a universal antidote targeted to reverse the direct thrombin and factor Xa inhibitors as well as the indirect inhibitor, enoxaparin.

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Acknowledgments

Dr. Ansell reports consultant activities and honoraria from Boehringer Ingelheim, Bristol Myers Squibb, Pfizer, Janssen, Daiichi Sankyo, Perosphere; and equity interest in Perosphere.

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Authors and Affiliations

  1. Hofstra North Shore/LIJ School of Medicine, Hempstead, NY, USA

    Jack E. Ansell

  2. 15 Waterview Way, Long Branch, NJ, 07740, USA

    Jack E. Ansell

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Correspondence to Jack E. Ansell.

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Ansell, J.E. Universal, class-specific and drug-specific reversal agents for the new oral anticoagulants. J Thromb Thrombolysis 41, 248–252 (2016). https://doi.org/10.1007/s11239-015-1288-1

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