• Vipa Thammatinno Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Keywords: specific antidote, DOACs, idarucizumab, andexanet alfa, ciraparantag


Currently, the use of Direct Oral Anticoagulants (DOACs) has become more common place since this group of drugs was developed to overcome the limitations of warfarin. However, inappropriate use of DOACs may increase the risk of bleeding. There is a need for an antidote which reverses this risk of bleeding from use or overuse of DOACs as well as to prevent bleeding associated with DOACs in patients undergoing emergency or elective surgery. Management guidelines are based on the level of urgency, severity and/or place of bleeding. Unfortunately, there is limited information regarding this reversal approach. Currently, specific antidotes for DOACs are being developed and approved for clinical use. The first approved specific antidote, idarucizumab, is indicated to reverse dabigatran’s effects in patients with a life-threatening haemorrhage or in need of urgent surgery. However, idarucizumab does not antagonize effects of other DOACs. In 2018, Andexanet alfa was approved by the USFDA for the reversal of apixaban’s and rivaroxaban’s effects. Lastly, ciraparantag, the universal antidote which reverses effects of both factor Xa inhibitors and factor IIa inhibitors, is under investigation.


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