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Review of Target-Specific Anticoagulation Reversal Agents
Keaton S Smetana1, Jacob Counts, Angad Sodhi
1Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus.
Critical Care Nursing Quarterly
|February 25, 2022
Summary
Direct oral anticoagulants (DOACs) cause many emergency visits, but reversal agents are now available. Research continues for effective reversal strategies for other anticoagulants and antiplatelets.
Area of Science:
- Pharmacology
- Emergency Medicine
- Cardiology
Background:
- Direct oral anticoagulants (DOACs) are increasingly prescribed, shifting away from warfarin.
- Bleeding complications from DOACs represent a significant cause of emergency department visits.
- Reversal agents for DOACs were previously unavailable, posing a challenge for managing life-threatening bleeds.
Purpose of the Study:
- To review currently available target-specific reversal agents for anticoagulants in the United States.
- To summarize investigational reversal agents for anticoagulants and antiplatelets currently in development.
- To highlight the importance of readily available reversal agents for DOAC-associated bleeds.
Main Methods:
- Literature review of available and pipeline anticoagulation reversal agents.
- Focus on agents approved or in clinical trials within the United States.
- Analysis of current prescribing trends and their impact on emergency care.
Main Results:
- Protamine, idarucizumab, and andexanet alfa are available target-specific reversal agents in the US.
- Several new reversal agents are in the pipeline for various anticoagulants and antiplatelets.
- The availability of reversal agents is crucial given the rise in DOAC use.
Conclusions:
- Target-specific reversal agents are essential for managing life-threatening bleeds associated with DOACs.
- Continued research and development of reversal strategies are imperative for anticoagulants and antiplatelets lacking specific antidotes.
- The availability of reversal agents supports the safe and effective use of modern anticoagulation therapies.
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