Efficacy of non-specific hemostatic agents for reversal of prophylactic apixaban levels
نویسندگان
چکیده
Introduction Apixaban (Eliquis) is a direct and competitive inhibitor of factor FXa that is approved for thrombosis prophylaxis after hip and knee replacement surgery, in non-valvular atrial fibrillation and venous thromboembolic events therapy [1]. In cases of severe hemorrhages there is no approved specific antidote available to reverse the effect of apixaban yet. Previous animal and in vitro studies [2,3] with supratherapeutic concentrations of apixaban (200ng ml) have shown that activated prothrombin complex concentrate (aPCC) and recombinant factor VIIa (rFVIIa) have a greater effect in reversing the effect of apixaban than prothrombin complex concentrate (PCC). The effect of these non-specific hemostatic agents for reversal of apixaban concentrations measured in patients after prophylactic doses (maximum observed plasma concentration 62 ng ml [4]) remains unclear.
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Clinical review: Clinical management of new oral anticoagulants: a structured review with emphasis on the reversal of bleeding complications
New oral anticoagulants, including dabigatran, rivaroxaban, and apixaban, have been recently approved for primary and secondary prophylaxis of thromboembolic conditions. However, there is no clear strategy for managing and reversing their anticoagulant effects. We aimed to summarize the available evidence for clinical management and reversal of bleeding associated with new oral anticoagulants. ...
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