Abdulrehman Jameel, Eikelboom John W, Siegal Deborah M
Division of Hematology, Department of Medicine, University Health Network, Toronto, ON, M5G 2C4, Canada.
Division of Hematology & Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada.
Future Cardiol. 2019 Nov;15(6):395-404. doi: 10.2217/fca-2019-0038. Epub 2019 Oct 31.
Direct oral anticoagulants are associated with lower rates of bleeding than vitamin K antagonists, but life-threatening bleeding still occurs. Andexanet alfa is a catalytically inactive recombinant modified human factor Xa molecule that reverses the anticoagulant effect of direct and indirect acting factor Xa inhibitors. In the ANNEXA-4 study, treatment with andexanet was associated with a 92% reduction in median anti-Xa activity levels and excellent or good hemostasis in 82% of patients presenting with serious bleeding while receiving apixaban or rivaroxaban. In this review, we discuss the burden of bleeding in anticoagulated patients and the need for reversal agents, review the mechanism of action of andexanet and critically evaluate the evidence for its efficacy and safety.
直接口服抗凝剂与比维生素K拮抗剂更低的出血发生率相关，但危及生命的出血仍会发生。安多凝血素α是一种催化失活的重组修饰人因子Xa分子，可逆转直接和间接作用的因子Xa抑制剂的抗凝作用。在ANNEXA - 4研究中，接受安多凝血素治疗的患者，其抗Xa活性水平中位数降低了92%，在接受阿哌沙班或利伐沙班治疗时出现严重出血的患者中，82%实现了良好或优异的止血效果。在本综述中，我们讨论了抗凝患者的出血负担以及对抗凝逆转剂的需求，回顾了安多凝血素的作用机制，并严格评估了其有效性和安全性的证据。
