Ability of recombinant factor VIIa to reverse the anticoagulant effect of the pentasaccharide fondaparinux in healthy volunteers.
BACKGROUND
The novel anticoagulant fondaparinux proved to be effective and safe in the postoperative prevention of venous thrombosis. Current phase III trials with this synthetic selective factor Xa inhibitor focus on its use in the treatment of patients with venous and arterial thrombosis. As with any anticoagulant therapy, there is a risk of bleeding complications; hence, a strategy to reverse the effects of fondaparinux is desirable. The aim of this study was to investigate whether recombinant factor VIIa (rFVIIa) could neutralize the anticoagulant effects of subcutaneously administered fondaparinux.


RESULTS
In a randomized, placebo-controlled design, 16 healthy male subjects received either a single subcutaneous dose of fondaparinux (10 mg) and a single intravenous bolus of rFVIIa (90 microg/kg; n=8), fondaparinux and placebo (n=4), or placebo and rFVIIa (n=4). Fondaparinux (or placebo) was administered 2 hours before rFVIIa (or placebo). Injection of rFVIIa after fondaparinux normalized the prolonged activated partial thromboplastin and prothrombin times and reversed the decrease in prothrombin activation fragments 1+2 (F(1+2)), as observed with fondaparinux alone. Thrombin-generation time and endogenous thrombin potential, which were inhibited by fondaparinux, normalized up to 6 hours after rFVIIa injection.


CONCLUSIONS
rFVIIa is capable of normalizing coagulation times and thrombin generation during fondaparinux treatment. The duration of this effect ranged from 2 to 6 hours after rFVIIa injection. These results suggest that rFVIIa may be useful to reverse the anticoagulant effect of fondaparinux in case of serious bleeding complications or need for acute surgery during treatment with fondaparinux.
Bijsterveld
Nick R
NR
Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands. n.r.bijsterveld@amc.uva.nl
Moons
Arno H
AH
Boekholdt
S Matthijs
SM
van Aken
Benien E
BE
Fennema
Hein
H
Peters
Ron J G
RJ
Meijers
Joost C M
JC
Büller
Harry R
HR
Levi
Marcel
M
D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000037:antagonists & inhibitors* / Q000097:blood; D001777:Blood Coagulation; D004311:Double-Blind Method; D005167:Factor VII / Q000032:analysis; D015942:Factor VIIa / Q000235:genetics / Q000494:pharmacology*; D000077425:Fondaparinux; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000037:antagonists & inhibitors* / Q000097:blood; D011994:Recombinant Proteins / Q000494:pharmacology; D013917:Thrombin / Q000378:metabolism; D013918:Thrombin Time
D000925:Anticoagulants; D011134:Polysaccharides; D011994:Recombinant Proteins; D005167:Factor VII; D015942:Factor VIIa; D013917:Thrombin; D000077425:Fondaparinux