![]() 1Īlthough, less is not absence of risk, as the anticoagulant effect intended as therapeutic also increases patient vulnerability to spontaneous, traumatic, and perioperative bleeding. ![]() Risk Remains With Direct-Acting AnticoagulantsĬiraparantag, is likely to be valued more as an antidote to multiple classes of anticoagulants rather than for including effects against the FIIa inhibitor dabigatran (Pradaxa, Boehringer Ingelhiem), as idarucizumab (Praxbind, Boehringer Ingelhiem) was approved as the specific antidote to dabigatran in 2015.Even without available antidotes, the direct-acting anticoagulants were welcomed as alternatives to the vitamin K antagonist warfarin, not only for relative ease of use, but for evidencing comparable or better efficacy in preventing stroke from nonvalvular atrial fibrillation and preventing and treating venous thromboembolism, with less likelihood of a major bleed. Additionally, ciraparantag (PER977, Perosphere) is in phase 2 trials as an antidote to both oral FXa inhibitor anticoagulants and subcutaneous low-molecular weight heparin (LMWH), as well as to factor IIa (FIIa, thrombin) inhibition. ![]() Although the factor Xa (FXa) inhibitor oral anticoagulants have fewer drug interactions and are without burdens associated with warfarin, such as blood test monitoring, dosage adjustment, and diet restriction, they also lack an approved antidote to their anticoagulant effect.Ī possible solution is underway as andexanet alfa (AndexXa, Portola Pharmaceuticals) is demonstrating safety and efficacy in reversing FXa inhibitors in phase 3 trials. ![]()
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