- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Predictors Of Intracranial Hemorrhage Volume Expansion In Patients Receiving Factor Xa Inhibitors In The Annexa-4 Trial (Hall F, Poster Hall; P126) - Feb 7, 2023 - Abstract #ISC2023ISC_823;
Shorter time from onset of symptoms to CT, lower GCS score and larger hematoma volumes at presentation increased the probability of ICrH expansion in FXa-associated ICrH treated with andexanet. These findings can inform the eligibility criteria of clinical trials targeting hemostatic efficacy in patients with FXa-associated ICrH.
- |||||||||| Review, Journal: Anticoagulation for Atrial Fibrillation: A Review of Current Literature and Views. (Pubmed Central) - Feb 3, 2023
One major concern and disadvantage for DOACs was lack of reversal agents, which have largely been ameliorated by the approval of Idarucizumab for dabigatran and Andexanet alfa for both apixaban and rivaroxaban, with Ciraparantag as a universal reversal agent for all DOACs undergoing Fast-Track Review from FDA. In this article, we will be providing a broad review of anticoagulation for atrial fibrillation with a focus on risk stratification schemes and anticoagulation agents (warfarin, aspirin, DOACs) including special clinical considerations.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Trial completion: Andexanet Alfa and 4F-PCC Use in Patients Hospitalised With an Anticoagulant-related Major Bleed (clinicaltrials.gov) - Jan 25, 2023
P=N/A, N=5480, Completed,
In this article, we will be providing a broad review of anticoagulation for atrial fibrillation with a focus on risk stratification schemes and anticoagulation agents (warfarin, aspirin, DOACs) including special clinical considerations. Recruiting --> Completed
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
ANDEXANET ALFA (ANDEXXA) REVIEW OF EFFICACY, SAFETY, AND TIME TO PATIENT ADMINISTRATION () - Jan 25, 2023 - Abstract #SCCM2023SCCM_1790;
In our study, patients admitted with intracranial hemorrhages secondary to apixaban or rivaroxaban use who received andexanet alfa for emergent reversal had excellent hemostatic outcomes with a low rate of adverse events. Most patients received andexanet alfa within an hour of order entry into the electronic health record and adhered to institutional prescribing restrictions.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
FIXED-DOSE FOUR-FACTOR PCC FOR THE REVERSAL OF FACTOR XA INHIBITOR-ASSOCIATED BLEEDING () - Jan 25, 2023 - Abstract #SCCM2023SCCM_1262;
The rates of effectiveness seen in the subset of patients with CNS bleeding are similar to what has previously been reported for a weight-based dosing strategy. Randomized prospective studies are needed comparing 4F-PCC to andexanet alfa, the FDA labeled reversal agent for factor Xa inhibitors.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
LACTOCOCCUS ENDOCARDITIS AFTER BENTALL PROCEDURE PRESENTING WITH INTRACRANIAL HEMORRHAGE (Poster Hall_Hall F) - Jan 4, 2023 - Abstract #ACCWCC2023ACC_WCC_6575;
With increasing use of bioprosthetic valves, the possibility of infective endocarditis with uncommon pathogens should be kept in mind. Lactococcus commonly affects native valves, however it can affect bioprosthetic valves and can present with mycotic aneurysms.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Journal: The use of andexanet alfa and 4-factor prothrombin complex concentrate in intracranial hemorrhage. (Pubmed Central) - Dec 5, 2022
The neutralization of various FXa inhibitors was dose and donor-dependent warranting dosage adjustment for optimal outcomes. This study suggests that real-world clinical and safety outcomes between andexanet alfa and 4F-PCC for the reversal of factor Xa inhibitors in the setting of ICH are similar to ones reported in clinical trials.
- |||||||||| Praxbind (idarucizumab) / Boehringer Ingelheim, AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Journal: A Historical Perspective on the Reversal of Anticoagulants. (Pubmed Central) - Nov 22, 2022
As the indications for DOACs and the overall prevalence of their use expand, there is an unmet need for further studies to determine the efficacy of specific compared with nonspecific pro-hemostatic reversal agents. In this review, we will discuss the evidence behind specific and nonspecific reversal agents for both parenteral and oral anticoagulants.
- |||||||||| Praxbind (idarucizumab) / Boehringer Ingelheim, AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Retrospective data, Review, Journal: Evaluation of Direct Oral Anticoagulant Reversal Agents in Intracranial Hemorrhage: A Systematic Review and Meta-analysis. (Pubmed Central) - Nov 12, 2022
All nonhuman studies and case reports, studies evaluating patients with ischemic stroke requiring anticoagulation reversal or different dosing regimens of DOAC reversal agents, and mixed study groups with DOAC and warfarin were excluded...A total of 36 studies met criteria for inclusion, with a total of 1832 patients (967 receiving 4-factor prothrombin complex concentrate [4F-PCC]; 525, andexanet alfa [AA]; 340, idarucizumab)...Idarucizumab for reversal of dabigatran had an anticoagulation reversal rate of 82% (95% CI, 55%-95%; I2 = 41%), all-cause mortality, 11% (95% CI, 8%-15%, I2 = 0%), and thromboembolic events, 5% (95% CI, 3%-8%; I2 = 0%)...In the absence of randomized clinical comparison trials, the overall anticoagulation reversal, mortality, and thromboembolic event rates in this systematic review and meta-analysis appeared similar among available DOAC reversal agents for managing ICH. Cost, institutional formulary status, and availability may restrict reversal agent choice, particularly in small community hospitals.
- |||||||||| Praxbind (idarucizumab) / Boehringer Ingelheim, AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Journal: Direct oral anticoagulants toxicity in children: an overview and practical guide. (Pubmed Central) - Oct 19, 2022
Vitamin K and fresh frozen plasma are ineffective for DOAC reversal and thus are not recommended. Currently, safety and efficacy data regarding the use of specific reversal agents (including idarucizumab and andexanet alfa) and 3-factor or 4-factor prothrombin complex concentrate (PCC) or activated PCC (aPCC) among children with DOAC-associated bleeding are lacking.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Observational data, Retrospective data, Journal: Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures. (Pubmed Central) - Oct 19, 2022
Andexanet alfa may be used for urgent or emergent reversal of apixaban and rivaroxaban peri-procedurally with promising hemostatic outcomes. Further prospective, comparative clinical research is warranted.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Volcano in A&E- Mixed anticoagulation overdose () - Oct 17, 2022 - Abstract #EUSEM2022EUSEM_1345;
The CT scan highlighted the active internal haemorrhage that was not obviously apparent from history and clinical examination alone. It played a crucial role in ruling out immediate intracranial or life-threatening internal haemorrhage.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Volcano in A&E- Mixed anticoagulation overdose () - Oct 17, 2022 - Abstract #EUSEM2022EUSEM_1344;
The CT scan highlighted the active internal haemorrhage that was not obviously apparent from history and clinical examination alone. It played a crucial role in ruling out immediate intracranial or life-threatening internal haemorrhage.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Volcano in A&E- Mixed anticoagulation overdose () - Oct 17, 2022 - Abstract #EUSEM2022EUSEM_1343;
The CT scan highlighted the active internal haemorrhage that was not obviously apparent from history and clinical examination alone. It played a crucial role in ruling out immediate intracranial or life-threatening internal haemorrhage.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Volcano in A&E- Mixed anticoagulation overdose () - Oct 17, 2022 - Abstract #EUSEM2022EUSEM_1342;
The CT scan highlighted the active internal haemorrhage that was not obviously apparent from history and clinical examination alone. It played a crucial role in ruling out immediate intracranial or life-threatening internal haemorrhage.
- |||||||||| Ciraparantag (aripazine) / Norgine, Covis Pharma
Review, Journal: A short review of ciraparantag in perspective of the currently available anticoagulant reversal agents. (Pubmed Central) - Oct 5, 2022
Ciraparantag, a synthetic small molecule that inactivates heparins and DOAC, is a promising new reversal agent that has been investigated in phase 2 trials. In this short review we provide an overview of the preclinical and clinical evidence of ciraparantag, and compare strengths and weaknesses of ciraparantag and the currently available anticoagulant reversal strategies.
- |||||||||| Praxbind (idarucizumab) / Boehringer Ingelheim, AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca, Ciraparantag (aripazine) / Norgine, Covis Pharma
Journal: Reversal agents for severe bleeding associated with direct oral anticoagulants (Pubmed Central) - Oct 5, 2022
Non-specific prohemostatic agents (e.g. prothrombin complex concentrate) can counteract the anticoagulant action of DOACs in emergency situations, when specific reversal agents are unavailable. However, specific reversal agents are efficacious and safe and should be preferred when available.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Journal: Andexanet-Alfa-Associated Heparin Resistance in the Context of Hemorrhagic Stroke. (Pubmed Central) - Oct 1, 2022
Although well known to hematologists, the phenomenon is underrecognized among stroke clinicians. However, patients with intracranial hemorrhage frequently undergo endovascular or surgical interventions that require periprocedural administration of heparin.
- |||||||||| Praxbind (idarucizumab) / Boehringer Ingelheim, AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Journal: Anticoagulation and bleeding in the cancer patient. (Pubmed Central) - Sep 29, 2022
Inferior vena cava (IVC) filter insertion can be also considered in those with major bleeding. Evidence for timing and need for re-initiation of anticoagulant therapy after a major bleeding remains sparse, but a multi-disciplinary approach and shared decision-making can be implemented in the interim.
- |||||||||| Praxbind (idarucizumab) / Boehringer Ingelheim, AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca, Ciraparantag (aripazine) / Norgine, Covis Pharma
Journal: Reversal of direct oral anticoagulants: what about new treatments available? (Pubmed Central) - Sep 18, 2022
These new molecules have shown excellent biological efficacy, hence supporting their use in clinical practice, however they are not routinely used, mainly due to limited availability and high cost. Ciraparantag, an antagonist of DOAC and heparins currently in phase III trials, could become a key molecule in the future considering encouraging preliminary results.
- |||||||||| Praxbind (idarucizumab) / Boehringer Ingelheim, AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Review, Journal: Management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiac surgery-a systematic review. (Pubmed Central) - Sep 11, 2022
It has been observed that andexanet alfa causes unresponsiveness to the anticoagulant effects of heparin...Expected results from the ongoing trials should provide better insights concerning the efficacy and safety of several potential solutions. Currently, the variability of reports and the deficit of high-quality studies in this specific setting represent the major limitation for the unbiased conclusion of this review.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Andexanet Alfa Induced Heparin Resistance Further Complicated By A Protamine Anaphylactoid Reaction (Hall C) - Aug 15, 2022 - Abstract #ASA2022ASA_4258;
During the case, baseline ACT was 115 and required 354 U/kg of heparin to achieve a satisfactory ACT of 219. Upon surgical completion protamine was given for heparin reversal leading to hypoxia, elevated peak airway pressure, hypotension from profound vasoplegia as evident on TEE, and a serum tryptase was normal.
- |||||||||| AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Journal: Andexanet alfa after 4-factor PCC administration for intracranial hemorrhage: a case series. (Pubmed Central) - Aug 13, 2022
The results highlight the potentially increased thrombotic risk associated with combination use. Ongoing post-marketing data collection of real patient case scenarios are essential to the establishment of consensus guidelines on how to prioritize initial reversal efforts and manage these patients during the course of their bleed.
- |||||||||| Praxbind (idarucizumab) / Boehringer Ingelheim, AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca
Journal: Dosing Medications for Coagulopathy Reversal in Patients with Extreme Obesity. (Pubmed Central) - Jul 31, 2022
In the meantime, doses listed in product labels should be used. Desmopressin should be dosed using either ideal body weight or a dose-capping strategy.
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