Milling Truman J, Kaatz Scott
Departments of Neurology and Surgery and Perioperative Care, Seton Dell Medical School Stroke Institute Austin, Tex.
Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI.
Am J Emerg Med. 2016 Nov;34(11S):39-45. doi: 10.1016/j.ajem.2016.09.052. Epub 2016 Sep 28.
Oral Factor Xa (FXa) inhibitors, a growing class of direct-acting anticoagulants, are frequently used to prevent stroke and systemic embolism in patients with atrial fibrillation and to prevent and treat venous thromboembolism. These drugs reduce the risk of clotting at the expense of increasing the risk of bleeding, and currently they have no specific reversal agent. However, andexanet alfa, a recombinant modified FXa decoy molecule, is in a late-phase clinical trial in bleeding patients, and ciraparantag, a small molecule that appears to reverse many anticoagulants including the FXa inhibitors, is in development. This review summarizes the published data to date on both drugs, which have the potential to change the management approach to patients with FXa inhibitoreassociated major hemorrhage.
口服Xa因子（FXa）抑制剂是一类不断发展的直接作用抗凝剂，常用于预防心房颤动患者的中风和全身性栓塞以及预防和治疗静脉血栓栓塞。这些药物以增加出血风险为代价降低凝血风险，目前尚无特异性逆转剂。然而，重组修饰的FXa诱饵分子andexanet alfa正在出血患者中进行晚期临床试验，而似乎能逆转包括FXa抑制剂在内的多种抗凝剂的小分子cirparantag正在研发中。本综述总结了迄今为止关于这两种药物的已发表数据，它们有可能改变FXa抑制剂相关大出血患者的管理方法。
