title: Preclinical and clinical data for factor Xa and "universal" reversal agents.
abstract: Oral Factor Xa (FXa) inhibitors, a growing class of direct-acting anticoagulants, are frequently used to prevent stroke and systemic embolism in patients with atrial fibrillation and to prevent and treat venous thromboembolism. These drugs reduce the risk of clotting at the expense of increasing the risk of bleeding, and currently they have no specific reversal agent. However, andexanet alfa, a recombinant modified FXa decoy molecule, is in a late-phase clinical trial in bleeding patients, and ciraparantag, a small molecule that appears to reverse many anticoagulants including the FXa inhibitors, is in development. This review summarizes the published data to date on both drugs, which have the potential to change the management approach to patients with FXa inhibitoreassociated major hemorrhage.
authors.affiliation: Departments of Neurology and Surgery and Perioperative Care, Seton Dell Medical School Stroke Institute Austin, Tex.
authors.forename: Truman J
authors.initials: TJ
authors.lastname: Milling
authors.affiliation: Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI. Electronic address: skaatz1@hfhs.org.
authors.forename: Scott
authors.initials: S
authors.lastname: Kaatz
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects*; D001120:Arginine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015951:Factor Xa / Q000494:pharmacology / Q000627:therapeutic use*; D065427:Factor Xa Inhibitors / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D010879:Piperazines / Q000494:pharmacology / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; C580915:PRT064445; D010879:Piperazines; D011994:Recombinant Proteins; D001120:Arginine; D015951:Factor Xa; C000593571:PER977