Andexanet, in contrast, has a much shorter half-life and is administered as a bolus and a two-hour continuous infusion. Idarucizumab practically irreversibly binds dabigatran and leads to excretion of the idarucizumab-dabigatran complex without prominent rebound phenomena. Displacing factor Xa inhibitors from native factor Xa contributes to normalization of the coagulation cascade, allowing for subsequent clot formation.Īnother important difference is in the practical use of andexanet. The mechanism of reversal then is a greater affinity for the various factor Xa inhibitors than human native factor Xa. Rather than a monoclonal antibody like idarucizumab, andexanet alfa is a modified, recombinant human factor Xa molecule. 2 This, like the Study of the RE-VERSal Effects of Idarucizumab on Active Dabigatran (RE VERSE-AD), details the efficacy of andexanet alfa as a reversal agent for the factor Xa inhibitors (eg, rivaroxaban, apixaban, edoxaban, and enoxaparin). Now, in a similar fashion, the full cohort results from the Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of FXA Inhibitors (ANNEXA-4) study have been released to great fanfare at the 2019 International Stroke Conference, with simultaneous publication in The New England Journal of Medicine. This situation has been improved with the availability of idarucizumab, the monoclonal antibody for reversal of dabigatran.1 We hope this antidote will produce clinically meaningful hemostasis following administration, but unfortunately, the best data available come to us from a single-arm trial. A specific antidote was not available, nor was a factor replacement strategy clearly efficacious. The introduction and initial popularity of dabigatran caught us lacking, with no useful options for managing hemorrhage. One-hour Acute Myocardial Infarction Rule-Out Not Ready for Prime TimeĮxplore This Issue ACEP Now: Vol 38 – No 04 – April 2019Į ver since the release of direct-acting oral anticoagulants, emergency physicians have been tasked with managing their associated complications.Blood-Thinner Reversal Agent Works in 82% of Serious Bleeding Cases.FDA Approves Praxbind as Reversal Agent for Pradaxa.

Xa inhibitor reversal