In this article, we review the pharmacology of these agents, the incidence and outcomes of haemorrhagic complications, the available strategies for anticoagulation reversal, and the more recent advances for the development of specific antidotes.Īnticoagulation, Bleeding, Reversal, Antidote, Non-vitamin K oral anticoagulants, Warfarin, Dabigatran, Rivaroxaban, Apixaban, Edoxaban, Andexanet alfa, Idarucizumab, Ciraparantag Introductionįor more than five decades, warfarin, a vitamin K antagonist, was the only oral anticoagulant available for prevention and treatment of thrombo-embolic disease. idarucizumab, andexanet alfa, and ciraparantag) show promising data, and may soon become available for clinical use. Since the introduction of NOACs, one of the major concerns for clinicians has been the lack of specific agents to reverse their anticoagulant effect in case of life-threatening haemorrhagic complications or emergency surgery, which have limited their use in patients deemed at a higher risk of bleeding. In addition, NOACs have a more predictable anticoagulant effect, allowing a fixed dose regimen and obviating the need for routine anticoagulation monitoring. Large randomized trials have demonstrated that these agents, which act by directly targeting thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, and edoxaban), are at least as effective as warfarin, with lower rates of bleeding and fewer interactions with food and drugs. In recent years, non-vitamin K oral anticoagulants (NOACs) have emerged as an alternative to warfarin for the prevention and treatment of thrombo-embolic disease.
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