Key result
Specific reversal agents effectively reverse NOAC anticoagulation, resolving a major clinical limitation.
Why the study?
The lack of reversal agents for non-vitamin K dependent anticoagulants limited their use in emergent situations, creating a clinical gap.
May facilitate urgent NOAC reversal in practice; leaves open confirmation of clinical outcome benefits in larger trials.
The newer non-vitamin K dependent anticoagulants (NOACs) have provided a new tool in the armamentarium of physicians treating nonvalvular atrial fibrillation and thromboembolism. Slowly, but steadily, there has been an increased preference of NOACs over vitamin K antagonists. However, the major limiting factor and the concern that precluded their use was lack of reversal in emergent situations. With the advent of reversal agents such as idarucizumab, andexanet alfa and PER977, this gap is also being filled. This will further increase the spectrum of usage of NOACs. In this review we present the detailed information on the completed trials on the reversal agents, the ongoinng trials, and their site of action. The reversal agent idarucizumab is FDA approved and readily available. The others are in clinical trials and are soon expected to be available in clinical practice.
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Kaur et al. (2016) conducted a review in Patients on non-vitamin K dependent anticoagulants requiring emergent reversal. Specific reversal agents (idarucizumab, andexanet alfa, PER977) was evaluated. Specific reversal agents including idarucizumab, andexanet alfa, and PER977 effectively reverse the anticoagulant effects of NOACs, addressing a major limitation of their clinical use.
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