Gómez-Outes Antonio, Suárez-Gea Mª Luisa, Lecumberri Ramón
Division of Pharmacology and Clinical Drug Evaluation, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Campezo 1, 28022, Madrid, Spain.
Hematology Service, University Clinic of Navarra, Pamplona, Spain.
Curr Cardiol Rep. 2023 May;25(5):371-380. doi: 10.1007/s11886-023-01858-x. Epub 2023 Mar 28.
Our objective is to describe currently available reversal agents for direct oral anticoagulants (DOACs), their target population, the available clinical practice recommendations and future directions.
Specific (idarucizumab for dabigatran and andexanet alfa for direct factor Xa inhibitors) and non-specific (prothrombin complex concentrates) reversal agents are effective in neutralizing the anticoagulant effect of DOACs. New investigational antidotes such as ciraparantag and VMX-C001 offer an alternative to andexanet alfa in reversing the anticoagulant activity of direct oral factor Xa inhibitors, but more clinical data are needed before they could be licensed for use. Specific reversal agents are recommended for use in clinical situations within their licensed indications (i.e.: reversal of DOACs in patients with severe uncontrolled or life-threatening bleeding or in need of emergency surgery or other invasive procedures), while non-specific reversal agents may be used when specific antidotes are not available or indicated.
我们的目标是描述目前可用的直接口服抗凝剂（DOACs）逆转剂、其目标人群、可用的临床实践建议及未来方向。
特异性逆转剂（达比加群用艾达凝血酶，直接Xa因子抑制剂用andexanet alfa）和非特异性逆转剂（凝血酶原复合物浓缩物）在中和DOACs的抗凝作用方面有效。新的研究性解毒剂如ciraparantag和VMX-C001在逆转直接口服Xa因子抑制剂的抗凝活性方面可作为andexanet alfa的替代选择，但在获得许可使用之前还需要更多临床数据。特异性逆转剂推荐用于其许可适应症范围内的临床情况（即：严重未控制或危及生命的出血患者、需要紧急手术或其他侵入性操作的患者中DOACs的逆转），而当无法获得或不适用特异性解毒剂时可使用非特异性逆转剂。
