title: Reversal of Newer Direct Oral Anticoagulant Drugs (DOACs).
abstract: Anticoagulation therapy is indicated for management of various clinical conditions to prevent adverse events and introduction of direct oral anticoagulants (DOACs) has ushered in a new era in anticoagulation therapy. Major advantages of DOACS include fewer drug interactions and that they do not need periodic monitoring. Several patients who were not on anticoagulation before due to older age, polypharmacy/drug interaction concerns, and logistics of periodic monitoring are now on anticoagulation with DOACs. Despite their many advantages, a challenge while prescribing DOACs is very limited availability of specific reversal agents and lack of understanding or guidance about the treatment strategy in case of major life threatening bleeding or need for urgent surgery. So far only one reversal agent has been approved by the Food and Drug Administration (FDA), idarucizumab for one of the DOACs i.e., dabigatran. Several other reversal agents are under final phases of development such as andexanet alfa and PER977 (ciraparantag) and will help in developing specific strategies for reversal of these agents. In this article, we review current strategies to manage bleeding with DOACs and provide guidance to clinicians of inhibiting LF activity in vitro and in cells, as well as in animal models of anthrax infection.
authors.forename: Saad S
authors.initials: SS
authors.lastname: Hussain
authors.forename: Alan H
authors.initials: AH
authors.lastname: Tyroch
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905, United States.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
mesh_terms: D000284:Administration, Oral; D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects*; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000517:prevention & control; D000069604:Dabigatran / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015951:Factor Xa / Q000627:therapeutic use; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D008958:Models, Molecular; D010879:Piperazines / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors; D065427:Factor Xa Inhibitors; C580915:PRT064445; D010879:Piperazines; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; D001120:Arginine; C000594745:idarucizumab; D015951:Factor Xa; D000069604:Dabigatran; C000593571:PER977
keywords: Andexanet alfa PER977 (ciraparantag); bleeding risk; direct oral anticoagulants (DOACs); idarucizumab; prothrombin concentrate (PCC); reversal agents