title: Universal, class-specific and drug-specific reversal agents for the new oral anticoagulants.
abstract: Although there is controversy about the absolute need for a reversal agent for the new direct oral anticoagulants (DOACs), the absence of such an agent is a barrier to more widespread use of these agents. For the management of major life-threatening bleeding with the DOACs, most authorities recommend the use of four factor prothrombin complex concentrates, although the evidence to support their use in terms of improving outcomes is meager. At the present time, there are three antidotes in development and poised to enter the market. Idarucizumab is a drug-specific antidote targeted to reverse the direct thrombin inhibitor, dabigatran. Andexanet alfa is a class-specific antidote targeted to reverse the oral direct factor Xa inhibitors as well as the indirect inhibitor, enoxaparin. Ciraparantag is a universal antidote targeted to reverse the direct thrombin and factor Xa inhibitors as well as the indirect inhibitor, enoxaparin.
authors.affiliation: Hofstra North Shore/LIJ School of Medicine, Hempstead, NY, USA. ansellje@gmail.com.|, 15 Waterview Way, Long Branch, NJ, 07740, USA. ansellje@gmail.com.
authors.forename: Jack E
authors.initials: JE
authors.lastname: Ansell
mesh_terms: D000284:Administration, Oral; D061067:Antibodies, Monoclonal, Humanized / Q000493:pharmacokinetics / Q000627:therapeutic use; D000931:Antidotes / Q000493:pharmacokinetics / Q000627:therapeutic use; D015951:Factor Xa / Q000493:pharmacokinetics / Q000627:therapeutic use; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D011994:Recombinant Proteins / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000931:Antidotes; D065427:Factor Xa Inhibitors; C580915:PRT064445; D011994:Recombinant Proteins; C000594745:idarucizumab; D015951:Factor Xa
keywords: Andexanet alfa; Anticoagulants; Antidotes; Ciraparantag; Direct oral anticoagulants; Idarucizumab; PER977; Reversal agents