Reversal of direct oral anticoagulants: guidance from the SSC of the ISTH
The currently approved direct oral anticoagulants (DOACs) are increasingly used in clinical practice. Although serious bleeding risks are lower with DOACs than with vitamin K antagonists, bleeding remains the most frequent side effect. Andexanet alfa and idarucizumab are the currently approved speci...
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| Veröffentlicht in: | Journal of thrombosis and haemostasis 2024-10, Vol.22 (10), p.2889-2899 |
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| container_title | Journal of thrombosis and haemostasis |
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| creator | Levy, Jerrold H. Shaw, Joseph R. Castellucci, Lana A. Connors, Jean M. Douketis, James Lindhoff-Last, Edelgard Rocca, Bianca Samama, Charles Marc Siegal, Deborah Weitz, Jeffrey I. |
| description | The currently approved direct oral anticoagulants (DOACs) are increasingly used in clinical practice. Although serious bleeding risks are lower with DOACs than with vitamin K antagonists, bleeding remains the most frequent side effect. Andexanet alfa and idarucizumab are the currently approved specific reversal agents for oral factor (F)Xa inhibitors and dabigatran, respectively. Our prior guidance document was published in 2016, but with more information available on the utility and increased use of these reversal agents and other bleeding management strategies, we have updated this International Society on Thrombosis and Haemostasis guidance document on DOAC reversal. In this narrative review, we compare the mechanism of action of specific and nonspecific reversal agents, review the clinical data supporting their use, and provide guidance on when reversal is indicated. In addition, we briefly discuss the reversal of oral FXIa inhibitors, a new class of DOACs currently under clinical development. |
| doi_str_mv | 10.1016/j.jtha.2024.07.009 |
| format | Article |
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Although serious bleeding risks are lower with DOACs than with vitamin K antagonists, bleeding remains the most frequent side effect. Andexanet alfa and idarucizumab are the currently approved specific reversal agents for oral factor (F)Xa inhibitors and dabigatran, respectively. Our prior guidance document was published in 2016, but with more information available on the utility and increased use of these reversal agents and other bleeding management strategies, we have updated this International Society on Thrombosis and Haemostasis guidance document on DOAC reversal. In this narrative review, we compare the mechanism of action of specific and nonspecific reversal agents, review the clinical data supporting their use, and provide guidance on when reversal is indicated. In addition, we briefly discuss the reversal of oral FXIa inhibitors, a new class of DOACs currently under clinical development.</description><identifier>ISSN: 1538-7836</identifier><identifier>EISSN: 1538-7836</identifier><identifier>DOI: 10.1016/j.jtha.2024.07.009</identifier><identifier>PMID: 39029742</identifier><language>eng</language><publisher>England: Elsevier Inc</publisher><subject><![CDATA[Administration, Oral ; andexanet ; Antibodies, Monoclonal, Humanized - administration & dosage ; Antibodies, Monoclonal, Humanized - adverse effects ; Antibodies, Monoclonal, Humanized - therapeutic use ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Anticoagulants - therapeutic use ; Arginine - analogs & derivatives ; bleeding ; Blood Coagulation - drug effects ; Dabigatran - administration & dosage ; Dabigatran - adverse effects ; direct oral anticoagulants ; Factor Xa - therapeutic use ; Factor Xa Inhibitors - administration & dosage ; Factor Xa Inhibitors - adverse effects ; Factor Xa Inhibitors - therapeutic use ; factor XI inhibitors ; Hemorrhage - chemically induced ; Humans ; idarucizumab ; Piperazines ; prothrombin complex concentrates ; Recombinant Proteins - administration & dosage ; Recombinant Proteins - therapeutic use ; Risk Factors ; Treatment Outcome]]></subject><ispartof>Journal of thrombosis and haemostasis, 2024-10, Vol.22 (10), p.2889-2899</ispartof><rights>2024 International Society on Thrombosis and Haemostasis</rights><rights>Copyright © 2024 International Society on Thrombosis and Haemostasis. 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Although serious bleeding risks are lower with DOACs than with vitamin K antagonists, bleeding remains the most frequent side effect. Andexanet alfa and idarucizumab are the currently approved specific reversal agents for oral factor (F)Xa inhibitors and dabigatran, respectively. Our prior guidance document was published in 2016, but with more information available on the utility and increased use of these reversal agents and other bleeding management strategies, we have updated this International Society on Thrombosis and Haemostasis guidance document on DOAC reversal. In this narrative review, we compare the mechanism of action of specific and nonspecific reversal agents, review the clinical data supporting their use, and provide guidance on when reversal is indicated. 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| subjects | Administration, Oral andexanet Antibodies, Monoclonal, Humanized - administration & dosage Antibodies, Monoclonal, Humanized - adverse effects Antibodies, Monoclonal, Humanized - therapeutic use Anticoagulants - administration & dosage Anticoagulants - adverse effects Anticoagulants - therapeutic use Arginine - analogs & derivatives bleeding Blood Coagulation - drug effects Dabigatran - administration & dosage Dabigatran - adverse effects direct oral anticoagulants Factor Xa - therapeutic use Factor Xa Inhibitors - administration & dosage Factor Xa Inhibitors - adverse effects Factor Xa Inhibitors - therapeutic use factor XI inhibitors Hemorrhage - chemically induced Humans idarucizumab Piperazines prothrombin complex concentrates Recombinant Proteins - administration & dosage Recombinant Proteins - therapeutic use Risk Factors Treatment Outcome |
| title | Reversal of direct oral anticoagulants: guidance from the SSC of the ISTH |
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