Article
Hematology
Spencer D. Davis, Stephanie Chauv, Abby W. Hickman, Dave S. Collingridge, Sara Kjerengtroen, Gabriel Fontaine
Summary: This study evaluated the weight-based dosing and outcomes of 4-factor prothrombin complex concentrate (4FPCC) in factor Xa (FXa) inhibitor-associated intracranial hemorrhage. It found that high-dose 4FPCC was associated with increased odds of achieving hemostasis in these patients.
THROMBOSIS RESEARCH
(2021)
Article
Multidisciplinary Sciences
Marwan Sheikh-Taha, R. Monroe Crawley
Summary: The use of aPCCs effectively achieves clinical hemostasis in patients with warfarin-associated major bleeding. 68.7% of patients achieved clinical hemostasis and 58.2% achieved target INR <1.5, but 7.5% developed thromboembolic complications.
SCIENTIFIC REPORTS
(2022)
Article
Emergency Medicine
Elly S. Oh, Paul Schulze, Frank Diaz, Kunal Shah, Jose Rios, Michael E. Silverman
Summary: This study compares the clinical and safety outcomes of andexanet alfa and 4-factor prothrombin complex concentrate for the reversal of apixaban or rivaroxaban-induced intracranial hemorrhage. The results show similar achievement of good hemostatic efficacy upon repeat CT scan between the two treatments, indicating that real-world outcomes align with clinical trial results.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2023)
Article
Emergency Medicine
Haithuy Pham, Whitney Gibson Medford, Spencer Horst, Melissa Levesque, David Ragoonanan, Christine Price, Harold Colbassani, Keaton Piper, Keith Chastain
Summary: This study compared the efficacy and safety of andexanet alfa and four-factor prothrombin complex concentrate in patients with intracranial hemorrhages related to oral factor Xa inhibitors. The results showed no significant differences between the two agents in terms of the primary and secondary outcomes, except for the total treatment cost. Therefore, there is currently insufficient evidence to recommend andexanet alfa over four-factor prothrombin complex concentrate.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Jack Ansell, Sasha Bakhru, Bryan E. Laulicht, Gregory Tracey, Stephen Villano, Daniel Freedman
Summary: The study evaluated the efficacy and safety of Ciraparantag in reversing anticoagulation induced by apixaban or rivaroxaban in healthy elderly adults. It was found that 60 mg of Ciraparantag achieved sustained reversal of apixaban, and 180 mg achieved sustained reversal of rivaroxaban. All doses of Ciraparantag were well tolerated by the subjects.
EUROPEAN HEART JOURNAL
(2022)
Article
Critical Care Medicine
H. Andrew Wilsey, Abby M. Bailey, Aric Schadler, George A. Davis, Melissa Nestor, Komal Pandya
Summary: This study compared hemostasis outcomes between patients receiving low- and high-dose 4F-PCC for the urgent reversal of apixaban and rivaroxaban, finding no significant difference in hemostasis efficacy or secondary outcomes such as thrombotic events and hospital mortality.
JOURNAL OF INTENSIVE CARE MEDICINE
(2021)
Review
Critical Care Medicine
Charlie J. Nederpelt, Leon Naar, Pieta Krijnen, Saskia le Cessie, Haytham M. A. Kaafarani, Menno V. Huisman, George C. Velmahos, Inger B. Schipper
Summary: This study combines evidence on andexanet alfa and prothrombin complex concentrates for factor Xa inhibitor-associated bleeding, finding no significant differences in clinical effectiveness between the two reversal agents, neither showing clear superiority nor increased adverse events.
CRITICAL CARE MEDICINE
(2021)
Review
Medicine, General & Internal
Rahul Chaudhary, Amteshwar Singh, Rohit Chaudhary, Michael Bashline, Damon E. Houghton, Alejandro Rabinstein, Jill Adamski, Richard Arndt, Narith N. Ou, Maria Rudis, Caitlin S. Brown, Erin D. Wieruszewski, Matthew Wanek, Nathan J. Brinkman, Jane A. Linderbaum, Melissa A. Sorenson, John L. Atkinson, Kristine M. Thompson, Aryan N. Aiyer, Robert D. McBane
Summary: The study evaluated the safety and outcomes of different DOAC reversal agents among patients with ICH, and found that the anticoagulation reversal rates and safety profiles of different reversal agents were similar. Additionally, there were no significant differences between 4F-PCC and AA in terms of anticoagulation reversal, mortality, or thromboembolic events.
Article
Hematology
Osamu Kumano, Shinya Suzuki, Masako Yamazaki, Yoshimori An, Masahiro Yasaka, Masahiro Ieko
Summary: This study developed a modified diluted prothrombin time (mdPT) assay that showed high reactivity to direct FXa inhibitors. The mdPT reagent exhibited a sharper slope and higher correlation to apixaban compared to commercial PT reagents, and comparable correlation to edoxaban and rivaroxaban.
INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Antonio Gomez-Outes, Pau Alcubilla, Gonzalo Calvo-Rojas, Ana Isabel Terleira-Fernandez, Luisa Suarez-Gea, Ramon Lecumberri, Emilio Vargas-Castrillon
Summary: This study investigated the clinical outcomes associated with the use of different reversal agents for severe DOAC-related bleeding, finding a high rate of effective hemostasis but a significant association between failure to achieve effective hemostasis and mortality risk. Thromboembolism rates were particularly high with andexanet.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2021)
Article
Chemistry, Medicinal
Hamin Kim, Tae-Jin Song, Jeong Yee, Dong-Hyeok Kim, Junbeom Park, Hye Sun Gwak
Summary: This study aimed to investigate the association between gene variants and bleeding complications during treatment with ABCG2 substrates (apixaban and rivaroxaban). The findings showed that the modified HAS-BLED score, a history of bleeding, concurrent use of PPI, ABCG2 rs3114018, and ABCB1 rs1045642 were significantly associated with the risk of bleeding complications in patients on apixaban and rivaroxaban.
DRUG DESIGN DEVELOPMENT AND THERAPY
(2023)
Article
Medicine, General & Internal
Gregory Y. H. Lip, Allison Keshishian, Yan Zhang, Amiee Kang, Amol D. Dhamane, Xuemei Luo, Christian Klem, Mauricio Ferri, Jenny Jiang, Huseyin Yuce, Steven Deitelzweig
Summary: In this study of patients with NVAF and high risk of GI bleed, NOACs were associated with lower rates of stroke and/or SE, but NOACs had varying risks of MB compared with warfarin. These results may help inform treatment options in this patient population.
Article
Hematology
Bethany T. Samuelson Bannow, Vivia Chi, Paul Sochacki, Owen J. T. McCarty, Maureen K. Baldwin, Alison B. Edelman
Summary: The study investigated rates of heavy menstrual bleeding (HMB) in users of rivaroxaban and apixaban, finding an association between rivaroxaban use and the need for medical or surgical intervention for HMB. Most women did not have a documented menstrual history, indicating that many providers do not inquire about menstrual bleeding when initiating anticoagulant therapy. Menstruating women, especially those with a history of HMB, may be at increased risk for HMB requiring medical treatment depending on the type of OAC used.
THROMBOSIS RESEARCH
(2021)
Article
Medicine, General & Internal
Brian T. Grainger, Eileen Merriman, Gordon Royle, Nicola Eaddy, Paul Ockelford, Laura Young
Summary: This study reviewed the real-world management of rivaroxaban-associated major bleeding in the public hospitals of New Zealand's largest city. The results showed considerable heterogeneity in the acute clinical management of these patients, with inconsistent use of prothrombin complex concentrate (PCC) and tranexamic acid (TXA). The study suggests that evidence-based guidance for treating rivaroxaban-related bleeding would improve the management and potentially improve clinical outcomes.
INTERNAL MEDICINE JOURNAL
(2023)
Article
Medicine, General & Internal
Anneka Mitchell, Julia Snowball, Tomas J. Welsh, Margaret C. Watson, Anita McGrogan
Summary: The study found a significant increase in the prescribing of oral anticoagulants for atrial fibrillation patients aged 75 years and older, but disparities still exist based on age and comorbidities. Elderly patients and those with comorbidities such as dementia, history of falls, major bleeds, and fractures were less likely to be prescribed oral anticoagulants.