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Direct-Acting Oral Anticoagulants and Their Reversal Agents—An Update

Department of Pharmaceutical Sciences, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC 27506, USA
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Author to whom correspondence should be addressed.
Received: 12 September 2019 / Revised: 10 October 2019 / Accepted: 14 October 2019 / Published: 15 October 2019
(This article belongs to the Section Oral Medicine and Dentistry)
Background: Over the last ten years, a new class of drugs, known as the direct-acting oral anticoagulants (DOACs), have emerged at the forefront of anticoagulation therapy. Like the older generation anticoagulants, DOACs require specific reversal agents in cases of life-threatening bleeding or the need for high-risk surgery. Methods: Published literature was searched, and information extracted to provide an update on DOACS and their reversal agents. Results: The DOACs include the direct thrombin inhibitor—dabigatran, and the factor Xa inhibitors—rivaroxaban, apixaban, edoxaban, and betrixaban. These DOACs all have a rapid onset of action and each has a predictable therapeutic response requiring no monitoring, unlike the older anticoagulants, such as warfarin. Two reversal agents have been approved within the last five years: idarucizumab for the reversal of dabigatran, and andexanet alfa for the reversal of rivaroxaban and apixaban. Additionally, ciraparantag, a potential “universal” reversal agent, is currently under clinical development. Conclusions: A new generation of anticoagulants, the DOACs, and their reversal agents, are gaining prominence in clinical practice, having demonstrated superior efficacy and safety profiles. They are poised to replace traditional anticoagulants including warfarin. View Full-Text
Keywords: andexanet alfa; anticoagulation; apixaban; betrixaban; dabigatran; direct oral anticoagulants; edoxaban; idarucizumab; rivaroxaban andexanet alfa; anticoagulation; apixaban; betrixaban; dabigatran; direct oral anticoagulants; edoxaban; idarucizumab; rivaroxaban
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MDPI and ACS Style

Kustos, S.A.; Fasinu, P.S. Direct-Acting Oral Anticoagulants and Their Reversal Agents—An Update. Medicines 2019, 6, 103. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines6040103

AMA Style

Kustos SA, Fasinu PS. Direct-Acting Oral Anticoagulants and Their Reversal Agents—An Update. Medicines. 2019; 6(4):103. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines6040103

Chicago/Turabian Style

Kustos, Stephanie A., and Pius S. Fasinu 2019. "Direct-Acting Oral Anticoagulants and Their Reversal Agents—An Update" Medicines 6, no. 4: 103. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines6040103

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