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Anticoagulants

Antidote to new oral anticoagulants proves effective

Anticoagulant effects of factor Xa inhibitors can be reversed by inactive recombinant factor Xa protein, andexanet, study shows.

Findings show that andexanet could provide a rapid antidote to factor Xa inhibitors (molecular structure pictured) for patients who experience bleeding or need emergency surgery

Source: Laguna Design / Science Photo Library

Andexanet (pictured) can reverse the blood thinning effects of new oral anticoagulants

The new oral anticoagulants apixaban, rivaroxaban and edoxaban (factor Xa inhibitors) are effective blood thinners. But an important clinical limitation is that, unlike warfarin, there is no antidote in the event of haemorrhage. 

But now, the results of two placebo-controlled trials, published in the New England Journal of Medicine (online, 11 November 2015)[1], show that the inactive recombinant factor Xa protein andexanet can reverse the anticoagulant effects of factor Xa inhibitors. 

Andexanet administration reduced anti-factor Xa activity by 94% and 92% in healthy volunteers who had received apixaban or rivaroxaban, respectively. Thrombin generation was fully restored in 100% and 96% of participants, respectively, and the effects were observed within two to five minutes. 

The researchers say that andexanet could provide a rapid antidote to factor Xa inhibitors for patients who experience bleeding or need emergency surgery.

  • This article was amended on the 23 November 2015 to correct a previous version that erroneously included dabigatran as a factor Xa inhibitor rather than edoxaban.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20200108

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Supplementary images

  • Findings show that andexanet could provide a rapid antidote to factor Xa inhibitors (molecular structure pictured) for patients who experience bleeding or need emergency surgery

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