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Drug Safety
Published in: Drug Safety 1/2016

01-01-2016 | Current Opinion

Reversal Strategies for NOACs: State of Development, Possible Clinical Applications and Future Perspectives

Authors: Steen Husted, Freek W. A. Verheugt, Willemijn J. Comuth

Published in: Drug Safety | Issue 1/2016

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Abstract

The non-vitamin K antagonist oral anticoagulants (NOACs) are used for thromboembolic prophylaxis of patients with atrial fibrillation and in the treatment as well as secondary prophylaxis of patients with venous thromboembolism. Even though NOACs have a better safety profile than vitamin K antagonists (VKAs), there will still be bleeding complications on NOAC treatment. In some cases, stopping the NOAC and non-drug-related management such as manual compression and interventional endoscopy will be sufficient to stop the bleeding. In more serious bleeding events and before acute surgery, coagulation factor concentrates or NOAC-specific antidotes could be used. Coagulation factor concentrates can be used in patients with haemophilia and to reverse the effect of VKAs but, in NOAC-treated patients, results are inconsistent and these agents could potentially have pro-thrombotic effects. Specific antidotes for NOACs are expected to be on the market soon. Phase III clinical trials with a humanized antibody fragment directed against dabigatran (idarucizumab) and recombinant, modified factor Xa (andexanet alfa) are ongoing. A molecule (aripazine) with broad activity against various anticoagulants including NOACs is currently undergoing phase II trials. For use of these specific antidotes, it is desirable that measurements for coagulation activity with a short response delay are widely available for the different NOACs and further research in this field is needed. Furthermore, guidelines for antidote use, including general measures for the treatment of NOAC-related bleeding, should be available.
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Metadata
Title
Reversal Strategies for NOACs: State of Development, Possible Clinical Applications and Future Perspectives
Authors
Steen Husted
Freek W. A. Verheugt
Willemijn J. Comuth
Publication date
01-01-2016
Publisher
Springer International Publishing
Published in
Drug Safety / Issue 1/2016
Print ISSN: 0114-5916
Electronic ISSN: 1179-1942
DOI
https://doi.org/10.1007/s40264-015-0357-x

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