keyword
https://read.qxmd.com/read/38467143/quantifying-residual-rivaroxaban-plasma-concentration-after-antagonization-with-andexanet-alfa-a-difficult-task-in-routine-clinical-practice
#1
JOURNAL ARTICLE
Alexander Mair, Gilles Huber, Jan-Dirk Studt, Donat R Spahn, Alexander Kaserer
We describe the case of a 38-year-old man with a history of chronic portal vein thrombosis who presented with abdominal pain after a transjugular intrahepatic portosystemic shunt procedure. Under anticoagulation therapy with rivaroxaban, he experienced active splenic bleeding, leading to hemodynamic instability. Emergency interventions, including andexanet alfa and nanoparticle administration, successfully stopped the bleeding. However, routine tests showed persistently high rivaroxaban levels despite reversal with andexanet alfa...
March 11, 2024: Hämostaseologie
https://read.qxmd.com/read/38444895/andexanet-alfa-for-reversal-of-direct-factor-xa-inhibitor-anticoagulation
#2
REVIEW
(no author information available yet)
No abstract text is available yet for this article.
February 2024: Australian Prescriber
https://read.qxmd.com/read/38430127/effect-of-low-versus-high-dose-4-factor-prothrombin-complex-concentrate-in-factor-xa-inhibitor-associated-bleeding-a-qualitative-systematic-review
#3
JOURNAL ARTICLE
Anna Phillips, Colby Bradley, Julie Cash, Ryan Sangiovanni, Charles Wingerson
DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The purpose of this review is to evaluate current literature on the treatment of factor Xa inhibitor-associated bleeds with 4-factor prothrombin complex concentrate (4F-PCC), with a focus on the effect of low versus high dosing of 4F-PCC on hemostatic efficacy and safety outcomes...
March 2, 2024: American Journal of Health-system Pharmacy: AJHP
https://read.qxmd.com/read/38412268/balfaxar-another-four-factor-pcc-for-warfarin-reversal
#4
JOURNAL ARTICLE
(no author information available yet)
No abstract text is available yet for this article.
February 19, 2024: Medical Letter on Drugs and Therapeutics
https://read.qxmd.com/read/38396232/andexanet-alfa-what-we-have-learned-from-clinical-trials-and-real-world-data
#5
JOURNAL ARTICLE
Senta Frol, Janja Pretnar Oblak, Mišo Šabovič, Pawel Kermer
Andexanet alfa is a specific reversal agent for factor Xa inhibitors with immediate reversal of their anticoagulant effect. Andexanet alfa is currently approved for use in patients treated with rivaroxaban and apixaban who have life-threatening or uncontrolled bleeding. New data from both controlled clinical trials and real-world experience are continuously being published, providing greater insight into the clinical characteristics of the drug, such as efficacy and safety. It is worth considering that andexanet alfa could be of benefit in a variety of different clinical scenarios where patients receiving treatment with apixaban and rivaroxaban (and endoxaban) have life-threatening conditions...
February 23, 2024: CNS Drugs
https://read.qxmd.com/read/38390987/direct-oral-anticoagulants-in-trauma-patients
#6
JOURNAL ARTICLE
Herbert Schöchl, Oliver Grottke, Felix C F Schmitt
PURPOSE OF REVIEW: Direct oral anticoagulants (DOACs) are increasingly prescribed for prevention of thromboembolic events. Thus, trauma care providers are facing a steadily raising number of injured patients on DOACs. RECENT FINDINGS: Despite a predictable pharmacokinetic profile, the resulting plasma levels of trauma patients upon admission and bleeding risks remain uncertain. Therefore, recent guidelines recommend the measurement of DOAC plasma concentrations in injured patients...
January 26, 2024: Current Opinion in Anaesthesiology
https://read.qxmd.com/read/38390922/antidote-vs-unspecific-hemostatic-agents-for-the-management-of-direct-oral-anticoagulant-related-bleeding-in-trauma
#7
JOURNAL ARTICLE
Jan Wienhold, Farahnaz Rayatdoost, Herbert Schöchl, Oliver Grottke
PURPOSE OF REVIEW: The advent of direct oral anticoagulants (DOACs) marks a significant milestone in anticoagulant treatment. However, DOACs can exacerbate bleeding, which is challenging for the treating clinician, especially when combined with traumatic injury. RECENT FINDINGS: In major bleeding associated with DOACs, rapid reversal of the anticoagulant effects is crucial. Recent observational and nonrandomized interventional trials have demonstrated the effectiveness of the specific antidotes andexanet alfa and idarucizumab as well as the unspecific prothrombin complex concentrates (PCCs) to counteract the anticoagulant effects of DOACs...
January 22, 2024: Current Opinion in Anaesthesiology
https://read.qxmd.com/read/38358898/the-use-of-andexanet-alfa-vs-4-factor-prothrombin-complex-concentrates-in-the-setting-of-life-threatening-intracranial-hemorrhage
#8
JOURNAL ARTICLE
Vivian M Irizarry-Gatell, Michael W Bacchus, Edward K De Leo, Yang Zhang, Carrie A Lagasse, Anna Y Khanna, Neil S Harris, Marc S Zumberg
OBJECTIVE: Andexanet alfa is a targeted reversal agent for life threatening hemorrhage associated with direct acting oral anticoagulants (DOACs), but there is uncertainty regarding the benefit when compared to 4-factor prothrombin complex concentrate (4F-PCC) for this indication. We investigated the clinical outcomes and cost associated with reversal of DOACs in the setting of life-threatening intracranial hemorrhage (ICH). METHODS: A retrospective evaluation was conducted to evaluate patients with ICH in the setting of anticoagulation with DOAC from 9/1/2013 to 4/30/2020...
February 13, 2024: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://read.qxmd.com/read/38350629/latest-advances-in-the-reversal-strategies-for-direct-oral-anticoagulants
#9
REVIEW
Jean Escal, Julien Lanoiselée, Géraldine Poenou, Paul Zufferey, Silvy Laporte, Patrick Mismetti, Xavier Delavenne
BACKGROUND: Since the late 2000s, Europe has granted approval for various thrombotic risk-related uses of direct oral anticoagulants (DOACs). Unlike traditional anticoagulants, DOACs do not necessitate routine coagulation monitoring. Nevertheless, clinical practice often encounters bleeding events associated with these medications, making the need for effective reversal strategies evident. OBJECTIVES: The study aims to take stock of current reversal strategies for DOACs, with a particular emphasis on the latest compounds that have been developed or are currently under development...
February 13, 2024: Fundamental & Clinical Pharmacology
https://read.qxmd.com/read/38285208/andexanet-alpha-induced-heparin-resistance-treated-by-nafamostat-mesylate-in-a-patient-undergoing-total-aortic-arch-repair-for-stanford-type-a-acute-aortic-dissection-a-case-report
#10
JOURNAL ARTICLE
Yasuhito Suzuki, Mutsuhito Kikura, Shingo Kawashima, Tetsuro Kimura, Yoshiki Nakajima
BACKGROUND: Andexanet alfa, an anti-Xa inhibitor antagonist, induces heparin resistance. Here, we report a case of successful management of cardiopulmonary bypass with andexanet alfa-induced heparin resistance using nafamostat mesylate. CASE PRESENTATION: An 84-year-old female, with Stanford type A acute aortic dissection, underwent an emergency surgery for total aortic arch replacement. Andexanet alfa 400 mg was administered preoperatively to antagonize edoxaban, an oral Xa inhibitor...
January 29, 2024: JA Clinical Reports
https://read.qxmd.com/read/38267194/four-factor-prothrombin-complex-concentrate-versus-andexanet-alfa-for-the-reversal-of-traumatic-brain-injuries
#11
JOURNAL ARTICLE
Erin Sadek, William Curtiss, Jessica Andrews, Jason Hecht
BACKGROUND: Andexanet alfa was approved in 2018 for reversal of direct oral anticoagulants but due to issues of cost and access, four-factor prothrombin complex concentrate (4F-PCC) continues to be used for this indication. The objective of this study is to evaluate outcomes of reversal with these agents in patients with isolated traumatic brain injuries (TBI). METHODS: This is a retrospective review of 35 trauma centres from 2014 to 2021. Patients were included with an Abbreviated Injury Scale (AIS)>2 for head and having received andexanet alfa or 4F-PCC within 24 hours of admission...
February 20, 2024: Emergency Medicine Journal: EMJ
https://read.qxmd.com/read/38264861/andexanet-alfa-vs-non-specific-treatments-for-intracerebral-hemorrhage-in-patients-taking-factor-xa-inhibitors-individual-patient-data-analysis-of-annexa-4-and-tich-noac
#12
JOURNAL ARTICLE
Bernhard Matthias Siepen, Alexandros A Polymeris, Ashkan Shoamanesh, Stuart Connolly, Thorsten Steiner, Sven Poli, Robin Lemmens, Martina Beatrice Goeldlin, Madlaine Müller, Mattia Branca, Janis Rauch, Thomas Meinel, Johannes Kaesmacher, Werner J Z'Graggen, Marcel Arnold, Urs Fischer, Nils Peter, Stefan Engelter, Philippe A Lyrer, David J Seiffge
BACKGROUND: Data comparing the specific reversal agent andexanet alfa with non-specific treatments in patients with non-traumatic intracerebral hemorrhage (ICH) associated with factor-Xa inhibitor (FXaI) use are scarce. AIM: To determine the association between use of andexanet alfa (compared to non-specific treatments) with rate of hematoma expansion and thromboembolic complications in patients with FXaI-associated ICH. METHODS: We performed an individual patient data analysis combining two independent, prospective studies: ANNEXA-4 (180 patients receiving andexanet alfa, NCT02329327) and TICH-NOAC (63 patients receiving tranexamic acid or placebo +/- prothrombin complex concentrate, NCT02866838)...
January 24, 2024: International Journal of Stroke: Official Journal of the International Stroke Society
https://read.qxmd.com/read/38249168/a-case-of-andexanet-alfa-induced-heparin-resistance-in-emergent-aortic-surgery-successful-anticoagulation-management-using-antithrombin-administration
#13
Kazuyoshi Takagi, Tomofumi Fukuda, Kosuke Saku, Eiki Tayama
Andexanet alfa (AnAl) is utilized for the urgent reversal of direct oral anticoagulants (DOACs) in cases of severe bleeding. While the guidelines from the Society of Thoracic Surgeons recommend AnAl for urgent cardiac surgery in patients treated with DOACs, concerns persist regarding the potential of AnAl to induce heparin resistance. This report details the case of an 85-year-old woman diagnosed with acute type A aortic dissection, who received AnAl due to prior edoxaban use. During the emergent aortic surgery, she exhibited heparin resistance following the administration of unfractionated heparin (UFH)...
December 2023: Curēus
https://read.qxmd.com/read/38230495/recommendations-of-polish-cardiac-society-expert-regarding-the-use-of-andexanet-alpha-in-the-polish-context-an-interdisciplinary-protocol
#14
JOURNAL ARTICLE
Ewelina Kazimierczyk, Milena Dąbrowska, Marek Gierlotka, Katarzyna Kapica-Topczewska, Bartosz Karaszewski, Adam Kobayashi, Zbigniew Krasiński, Jacek Kubica, Alina Kułakowska, Krzysztof Kurek, Robert Ładny, Eliza Pleban, Konrad Rejdak, Grażyna Rydzewska, Agnieszka Słowik, Piotr Szopiński, Arkadiusz Woźniak, Agnieszka Tycińska
Andexanet alfa (AA) is a recombinant, inactive analog of human factor Xa (FXa), effectively reversing the effects of its inhibitors - rivaroxaban and apixaban, which are available in Poland. The drug was granted registration after the publication of the ANNEXA-4 trial (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of FXA Inhibitors 4), in which its efficacy in restoring hemostasis in life-threatening hemorrhages in a group of patients using the aforementioned anticoagulants was proven. Hence, AA is now recommended for patients receiving apixaban or rivaroxaban therapy with massive and uncontrollable hemorrhages, including hemorrhagic strokes (HS) and gastrointestinal bleeding...
January 17, 2024: Kardiologia Polska
https://read.qxmd.com/read/38180321/treatment-of-atrial-fibrillation
#15
JOURNAL ARTICLE
(no author information available yet)
No abstract text is available yet for this article.
January 8, 2024: Medical Letter on Drugs and Therapeutics
https://read.qxmd.com/read/38148268/cardiopulmonary-bypass-circuit-obstruction-and-urgent-replacement-after-the-administration-of-andexanet-alfa
#16
Yusaku Nozumi, Yuta Yonezawa, Kazuma Yunoki, Hiroyuki Mima
No abstract text is available yet for this article.
December 6, 2023: Journal of Cardiothoracic and Vascular Anesthesia
https://read.qxmd.com/read/38071150/andexanet%C3%A2-alfa-or-prothrombin-complex-concentrate-for-acute-reversal-of-oral-factor-xa-inhibitors-monitoring-of-antidote-effects
#17
EDITORIAL
Kenichi A Tanaka, Jerrold H Levy
This study in vitro comprehensively assessed reversal of the anticoagulant effects of rivaroxaban, an oral factor Xa inhibitor, using andexanet alfa and various prothrombin complex concentrate (PCC) products in a battery of tests. In static coagulation assays, andexanet alpha outperformed PCCs except for activated PCC being more effective in standard coagulation times. However, in a flow chamber model mimicking arterial shear, both andexanet alpha and high-concentration PCC restored fibrin formation, but not platelet adhesion...
February 2024: British Journal of Anaesthesia
https://read.qxmd.com/read/38030550/comparative-analysis-of-andexanet%C3%A2-alfa-and-prothrombin-complex-concentrate-in-reversing-anticoagulation-by-rivaroxaban-ex%C3%A2-vivo
#18
COMPARATIVE STUDY
Farahnaz Rayatdoost, Katharina Deventer, Rolf Rossaint, Herbert Schöchl, Oliver Grottke
BACKGROUND: The comparative effectiveness of the specific antidote andexanet alfa vs the nonspecific therapy four-factor prothrombin complex concentrates (4F-PCCs) as reversal agents for direct factor Xa (FXa) inhibitors in severely bleeding patients is unclear. We hypothesised that specific reversal using andexanet alfa would be more effective than a high dose of PCC (50 IU kg-1 ) for reversing the FXa inhibitor rivaroxaban. METHODS: The reversal potential of andexanet alfa, various 4F-PCCs, and activated PCC was investigated ex vivo in human blood anticoagulated with rivaroxaban (37...
February 2024: British Journal of Anaesthesia
https://read.qxmd.com/read/37965168/case-report-first-treatment-of-acute-ischaemic-stroke-in-a-patient-on-active-rivaroxaban-therapy-using-andexanet-alfa-and-rtpa-combined-with-early-complete-recovery
#19
Bartosz Karaszewski, Sebastian Szczyrba, Bartosz Jabłoński, Dariusz Gąsecki, Piotr Kraszewski, Adam Wyszomirski, Robert Kowalski, Wioletta Kaliszan, Małgorzata Dąbrowska
UNLABELLED: Patients with non-large vessel occlusion acute ischemic stroke (NL-AIS) on oral anticoagulants (OAC) constitute the biggest portion among those who cannot receive any potential-reperfusion treatment even if they appear early in the hospital. We present the first case of therapy for NL-AIS in a patient with active anti-Xa anticoagulation, combining andexanet alfa and rtPA, who was recruited for STRoke On AntiCoagulants for Thrombolysis (acronym: STROACT), an ongoing therapeutic trial for non-LVO ischemic stroke on a DOAC...
2023: Frontiers in Neurology
https://read.qxmd.com/read/37952844/four-factor-prothrombin-complex-concentrate-versus-andexanet-alfa-for-direct-oral-anticoagulant-reversal
#20
JOURNAL ARTICLE
Soo Jin Koo, Yunus Hussain, Deborah Y Booth, Payal Desai, Elly S Oh, Jose Rios, Kristen Audley
BACKGROUND: Optimal reversal agent for direct oral anticoagulant (DOAC)-associated major bleeding has not been described. Before the approval of andexanet alfa (AA) in 2018, four-factor prothrombin complex concentrate (4F-PCC) was recommended by major guidelines. Currently, AA is recommended as the first-line agent by most guidelines. With a paucity of literature comparing the two agents, there is clinical value in assessing hemostatic efficacy and safety of the two agents. OBJECTIVE: The objective of this study is to evaluate hemostatic efficacy and safety of AA and 4F-PCC in all DOAC-associated major bleedings...
November 10, 2023: Journal of the American Pharmacists Association: JAPhA
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