January 2016: Reversal Agents for Factor Xa, Direct Thrombin Inhibitors and Warfarin
Our first JC of the New Year brings wishes for health, happiness and of course, record JC participation. This month, we will be looking at reversal agents for the acutely bleeding patient who happens to be on a Direct Thrombin Inhibitor such as dabigatran (Pradaxa) or bivalirudin (Angiomax), a Factor Xa inhibitor such as rivaroxaban (Xarelto), apixaban (Elequis) or fondaparinux (Arixtra) or, the Vitamin K antagonist warfarin. Praxbind, a Pradaxa reversal agent was recently given fast-track FDA approval based upon an interim data analysis (RE-VERSE AD) published in the NEJM. We will also look at the ANNEXA trial, a volunteer study that looked at reversal agents for two Factor Xa drugs (rivaroxaban and apixaban). Also included, is a recent trial that may add to the evidence supporting the use of PCC for warfarin reversal. Finally, a brief article from the NY Times by Atul Gawandi called The Best Possible Day. I'd like to use the article as an introduction for a future JC dedicated to this important topic and encourage everyone to have a look.
Goldstein JN et.al, Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet. 2015 May 23;2077-87 Appraisal