The Specific Direct Oral Anticoagulant Reversal Agents: Their Current Status and Future Place in Gastroenterology Practice

摘要

In comparison with warfarin, the anticoagulant effect of the direct oral anticoagulants (DOACs) is short-lived, with restoration of normal hemostasis within 12-24 h of last drug dose in most patients. In rare situations, such as life-threatening bleeding or need for emergency surgery, a specific, immediate-onset DOAC reversal agent would benefit clinical management. This paper summarizes the current status of the specific DOAC reversal agents and discusses their potential role in gastroenterology practice. A dabigatran reversal agent, idarucizumab, is available for clinical use. Pre-market data demonstrate that idarucizumab achieves immediate, complete, and sustained reversal of the anticoagulant effect of dabigatran. Andexanet alfa, a specific reversal agent for the factor Xa inhibitors, is in late-stage clinical development and will most likely gain regulatory approval during 2016. Available data suggest that andexanet alfa achieves immediate and complete reversal of anticoagulant activity associated with the factor Xa inhibitors. A third DOAC reversal agent, ciraparantag, is in early development. The specific DOAC reversal agents represent an important advance in the management of DOAC users experiencing life-threatening gastrointestinal bleeding or surgical emergencies.