Antidotes for the new oral anticoagulants: Reality and expectations

Various oral anticoagulants have been marketed in the last decade, dabigatran etexilate being among them, a direct thrombin inhibitor (Pradaxa®; Boehringer Ingelheim), and the direct inhibitors of x activated factor (FXa), rivaroxaban (Xarelto®; Bayer HealthCare), apixaban (Eliquis®; Bristol-Myers Squibb) and edoxaban (Lixiana®/Savaysa®; Daiichi Sankyo-).

These (not so new) oral anticoagulants of direct action (DOAC) are authorized for use in various indications related to the prophylaxis and treatment of venous thromboembolism and the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF).

The DOAC have shown a positive risk–benefit relationship in such indications and a lower haemorrhagic tendency (especially in the case of intracranial haemorrhage [ICH]) than vitamin K antagonists (VKA).

The relatively short half-life (between 11 and 17 h in patients with normal renal function) can be an advantage in case of bleeding, as it quickly decreases its anticoagulant action between 12 and 24 h after administration.

However, the absence of a specific antidote and tools for the biological control of the anticoagulant effect which are well standardized and available in any emergency laboratory has generated some distrust between prescribers and patients.

CITATION  Med Clin (Barc). 2016 Jun 3;146(11):488-90. doi: 10.1016/j.medcli.2015.11.014