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A Review on the Use of Reversal Agents of Direct Oral Anticogulant Drugs in Case of Gastrointestinal Bleeding.
Rev Recent Clin Trials. 2020 Jun 24 [Online ahead of print]RR

Abstract

BACKGROUND

Major bleeding is a life-threatening condition and a medical emergency with high mortality risk. It is often the complication of anticoagulant's intake. Anticoagulants are commonly used for the prevention and the treatment of thrombotic events. The standard therapy with vitamin K antagonist (warfarin) has been frequently replaced by direct oral anticoagulants (DOACs). The latter agents (rivaroxaban, apixaban, edoxaban, dabigatran, betrixaban) showed a better efficacy and safety compared to standard warfarin treatment and they are recommended for the reduction of ischemic stroke. Literature data reported a high risk of gastrointestinal bleeding with DOACs, in particular with dabigatran and rivaroxaban. In case of life-threatening gastrointestinal bleeding, these patients could benefit from the use of reversal agents.

METHODS

We performed an electronic search on PUBMED of the literature concerning reversal agents for DOACs and gastrointestinal bleeding in the Emergency Department from 2004 to 2020.

AIM

This review summarizes the current evidences about three reversal agents idarucizumab, andexanet alfa and ciraparantag, and the use of the first two in the emergency setting in patients with an active major bleeding or who need urgent surgery to offer physicians indications for a better management approach in order to increase patient's safety.

CONCLUSION

Although these agents have been marketed for five years (idarucizumab) and two years (andexanet alfa) respectively, and despite guidelines considering antidotes as first-line agents in treating life-threatening hemorrhage when available, these antidotes seem to gain access very slowly in the clinical practice. Cost, logistical aspects and need for plasma level determination of DOAC for an accurate therapeutic use probably have an impact on this phenomenon.. An expert multidisciplinary bleeding team should be established so as to implement international guidelines based on local resources and organization.

Authors+Show Affiliations

Department of Emergency Medicine Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome. Italy.Università Cattolica del Sacro Cuore, Rome. Italy.Università Cattolica del Sacro Cuore, Rome. Italy.Department of Emergency Medicine Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome. Italy.Department of Emergency Medicine Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome. Italy.Department of Emergency Medicine Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome. Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32579506

Citation

Ojetti, Veronica, et al. "A Review On the Use of Reversal Agents of Direct Oral Anticogulant Drugs in Case of Gastrointestinal Bleeding." Reviews On Recent Clinical Trials, 2020.
Ojetti V, Saviano A, Brigida M, et al. A Review on the Use of Reversal Agents of Direct Oral Anticogulant Drugs in Case of Gastrointestinal Bleeding. Rev Recent Clin Trials. 2020.
Ojetti, V., Saviano, A., Brigida, M., Saviano, L., Migneco, A., & Franceschi, F. (2020). A Review on the Use of Reversal Agents of Direct Oral Anticogulant Drugs in Case of Gastrointestinal Bleeding. Reviews On Recent Clinical Trials. https://doi.org/10.2174/1574887115666200624193938
Ojetti V, et al. A Review On the Use of Reversal Agents of Direct Oral Anticogulant Drugs in Case of Gastrointestinal Bleeding. Rev Recent Clin Trials. 2020 Jun 24; PubMed PMID: 32579506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Review on the Use of Reversal Agents of Direct Oral Anticogulant Drugs in Case of Gastrointestinal Bleeding. AU - Ojetti,Veronica, AU - Saviano,Angela, AU - Brigida,Mattia, AU - Saviano,Luisa, AU - Migneco,Alessio, AU - Franceschi,Francesco, Y1 - 2020/06/24/ PY - 2020/02/01/received PY - 2020/03/25/revised PY - 2020/04/27/accepted PY - 2020/6/25/entrez PY - 2020/6/25/pubmed PY - 2020/6/25/medline KW - DOACs KW - andexanet alfa KW - bleeding KW - ciraparantag KW - idarucizumab KW - reversal agents JF - Reviews on recent clinical trials JO - Rev Recent Clin Trials N2 - BACKGROUND: Major bleeding is a life-threatening condition and a medical emergency with high mortality risk. It is often the complication of anticoagulant's intake. Anticoagulants are commonly used for the prevention and the treatment of thrombotic events. The standard therapy with vitamin K antagonist (warfarin) has been frequently replaced by direct oral anticoagulants (DOACs). The latter agents (rivaroxaban, apixaban, edoxaban, dabigatran, betrixaban) showed a better efficacy and safety compared to standard warfarin treatment and they are recommended for the reduction of ischemic stroke. Literature data reported a high risk of gastrointestinal bleeding with DOACs, in particular with dabigatran and rivaroxaban. In case of life-threatening gastrointestinal bleeding, these patients could benefit from the use of reversal agents. METHODS: We performed an electronic search on PUBMED of the literature concerning reversal agents for DOACs and gastrointestinal bleeding in the Emergency Department from 2004 to 2020. AIM: This review summarizes the current evidences about three reversal agents idarucizumab, andexanet alfa and ciraparantag, and the use of the first two in the emergency setting in patients with an active major bleeding or who need urgent surgery to offer physicians indications for a better management approach in order to increase patient's safety. CONCLUSION: Although these agents have been marketed for five years (idarucizumab) and two years (andexanet alfa) respectively, and despite guidelines considering antidotes as first-line agents in treating life-threatening hemorrhage when available, these antidotes seem to gain access very slowly in the clinical practice. Cost, logistical aspects and need for plasma level determination of DOAC for an accurate therapeutic use probably have an impact on this phenomenon.. An expert multidisciplinary bleeding team should be established so as to implement international guidelines based on local resources and organization. SN - 1876-1038 UR - https://www.unboundmedicine.com/medline/citation/32579506/A_Review_on_the_Use_of_Reversal_Agents_of_Direct_Oral_Anticogulant_Drugs_in_Case_of_Gastrointestinal_Bleeding L2 - http://www.eurekaselect.com/183118/article DB - PRIME DP - Unbound Medicine ER -
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