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. 

Pollack CV Jr et al, Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015 Aug 6;373(6):511-20.         Appraisal

Siegal DM et.al, Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med. 2015 Dec 17;373(25):2413-24. Appraisal

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

Atul Gawandi, MD The Best Possible Day SundayReview |  NY Times OPINION OCT. 5, 2014