scholarly journals Clinical Applications of 4-Factor Prothrombin Complex Concentrate: A Practical Pathologist's Perspective

2014 ◽  
Vol 139 (12) ◽  
pp. 1568-1575 ◽  
Author(s):  
David Unold ◽  
Christopher A. Tormey
Keyword(s):  
Vitamin K ◽  
Prothrombin Complex Concentrate ◽  
Oral Anticoagulants ◽  
Coagulation Factors ◽  
The United States ◽  
Vitamin K Antagonist ◽  
Reversal Agents ◽  
Therapeutic Doses ◽  
Potential Use

A 4-factor prothrombin complex concentrate (4F-PCC), containing therapeutic doses of vitamin K–dependent coagulation factors, was recently licensed in the United States for reversal of vitamin K antagonist therapy. However, given the emergence of several oral anticoagulants for which there are no specific reversal agents, and the existence of many other complex bleeding disorders, it is likely that clinicians will seek to use 4F-PCCs for any number of off-label indications. Thus, the goal of this review is to explore practical issues regarding 4F-PCC, with an emphasis on issues relevant to blood bankers and pathologists. Specifically, our aims are to (1) examine the role of 4F-PCC in vitamin K antagonist reversal, (2) review its potential use in the treatment of hemorrhage due to novel oral anticoagulants, and (3) explore potential uses in liver disease, trauma-associated bleeding, and rare coagulopathies. Safety and other practical considerations of 4F-PCCs will also be discussed.

HEMATURIA AND OTHER KINDS OF BLEEDINGS ON NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION: AN UPDATED OVERVIEW ON OCCURRENCE, PATHOMECHANISMS AND MANAGEMENT

2020 ◽  
Vol 73 (11) ◽  
pp. 2528-2534
Author(s):  
Dagmara Wojtowicz ◽  
Anna Tomaszuk-Kazberuk ◽  
Jolanta Małyszko ◽  
Marek Koziński
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Anticoagulant Activity ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Bleeding Complications ◽  
Reversal Agents ◽  
Limited Availability ◽  
Increased Risk

Non-vitamin K antagonist oral anticoagulants (NOACs) are currently recommended for oral anticoagulation in patients with non-valvular atrial fibrillation. In the setting, NOACs effectively prevent from stroke and systemic embolic events. In spite of the favorable safety profile of NOACs when compared with vitamin K antagonists, the use of any kind of anticoagulation is associated with an increased risk of bleeding. However, there is still a lack of direct comparisons of effectiveness and safety among NOACs. The results of indirect comparisons and meta-analyses suggest that the risk of various types of hemorrhagic complications differ among the particular NOACs. Management of bleeding in patients under NOAC therapy can be challenging because of limited availability of antidotes and the lack of routine laboratory test monitoring the NOAC anticoagulant effect. In case of life-threatening or critical site bleeding, reversal of NOAC anticoagulant activity is essential together with immediate implementation of causative treatment. Moreover, some patients on chronic NOAC therapy may require urgent surgery or invasive procedures. Specific reversal agents for NOACs have been developed, i.e. more widely available idarucizumab for the factor IIa inhibitor (dabigatran) and andexanet alfa for the factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) with limited availability. This review summarizes the occurrence and management of NOAC-related bleeding complications with a particular emphasis on hematuria.

Reversal agents for non-vitamin K antagonist oral anticoagulants

2018 ◽  
Vol 15 (5) ◽  
pp. 273-281 ◽  
Author(s):  
Jerrold H. Levy ◽  
James Douketis ◽  
Jeffrey I. Weitz
Keyword(s):  
Vitamin K ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Reversal Agents

scholarly journals An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Mark Terence P. Mujer ◽  
Manoj P. Rai ◽  
Varunsiri Atti ◽  
Ian Limuel Dimaandal ◽  
Abigail S. Chan ◽  
...  
Keyword(s):  
Vitamin K ◽  
Oral Anticoagulants ◽  
Coagulation Factor ◽  
Heart Association ◽  
Vitamin K Antagonist ◽  
Thrombin Inhibitor ◽  
Minor Bleeding ◽  
Onset Of Action ◽  
Reversal Agents ◽  
Andexanet Alfa

Non-vitamin K antagonist oral anticoagulants (NOACs) include thrombin inhibitor dabigatran and coagulation factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and betrixaban. NOACs have several benefits over warfarin, including faster time to the achieve effect, rapid onset of action, fewer documented food and drug interactions, lack of need for routine INR monitoring, and improved patient satisfaction. Local hemostatic measures, supportive care, and withholding the next NOAC dose are usually sufficient to achieve hemostasis among patients presenting with minor bleeding. The administration of reversal agents should be considered in patients on NOAC's with major bleeding manifestations (life-threatening bleeding, or major uncontrolled bleeding), or those who require rapid anticoagulant reversal for an emergent surgical procedure. The Food and Drug Administration (FDA) has approved two reversal agents for NOACs: idarucizumab for dabigatran and andexanet alfa for apixaban and rivaroxaban. The American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS) have released an updated guideline for the management of patients with atrial fibrillation that provides indications for the use of these reversal agents. In addition, the final results of the ANNEXA-4 study that evaluated the efficacy and safety of andexanet alfa were recently published. Several agents are in different phases of clinical trials, and among them, ciraparantag has shown promising results. However, their higher cost and limited availability remains a concern. Here, we provide a brief review of the available reversal agents for NOACs (nonspecific and specific), recent updates on reversal strategies, lab parameters (including point-of-care tests), NOAC resumption, and agents in development.

scholarly journals The role of non-vitamin K antagonist oral anticoagulants in Asian patients with atrial fibrillation

Medicine ◽  
2020 ◽  
Vol 99 (27) ◽  
pp. e21025
Author(s):  
Xuyang Liu ◽  
Manxiang Huang ◽  
Caisheng Ye ◽  
Junquan Zeng ◽  
Changai Zeng ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Asian Patients

scholarly journals Direct Oral Anticoagulants after Ischemic Stroke: Which Patient? Which Drug? And How Early?

2021 ◽  
Vol 41 (01) ◽  
pp. 031-034
Author(s):  
Gian Marco De Marchis
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Vitamin K ◽  
Randomized Clinical Trials ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Reversal Agents

AbstractDirect oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and ischemic stroke. The main advantage of DOAC over VKA is the lower rate of bleeding and mortality. This review covers challenges clinicians can encounter when treating patients with AF and ischemic stroke, including timing of DOAC start and ongoing randomized clinical trials, appropriate dosing, and available comparative evidence across DOACs. For patients without AF but with an ischemic stroke, the review outlines the role of DOACs. Finally, the risk of thrombotic events associated with specific DOAC reversal agents and DOAC pausing is reviewed.

scholarly journals Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations

2020 ◽  
Vol 15 (2) ◽  
pp. 133-142
Author(s):  
Kwang-Sub Kim ◽  
Jong Wook Song ◽  
Sarah Soh ◽  
Young-Lan Kwak ◽  
Jae-Kwang Shim
Keyword(s):  
Vitamin K ◽  
Clinical Evidence ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Bleeding Risk ◽  
Vitamin K Antagonist ◽  
Thrombin Inhibitor ◽  
Reversal Agents ◽  
Perioperative Bleeding ◽  
Number Of Patients

Indications of non-vitamin K antagonist oral anticoagulants (NOACs), consisting of two types: direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitor (rivaroxaban, apixaban, and edoxaban), have expanded over the last few years. Accordingly, increasing number of patients presenting for surgery are being exposed to NOACs, despite the fact that NOACs are inevitably related to increased perioperative bleeding risk. This review article contains recent clinical evidence-based up-to-date recommendations to help set up a multidisciplinary management strategy to provide a safe perioperative milieu for patients receiving NOACs. In brief, despite the paucity of related clinical evidence, several key recommendations can be drawn based on the emerging clinical evidence, expert consensus, and predictable pharmacological properties of NOACs. In elective surgeries, it seems safe to perform high-bleeding risk surgeries 2 days after cessation of NOAC, regardless of the type of NOAC. Neuraxial anesthesia should be performed 3 days after cessation of NOACs. In both instances, dabigatran needs to be discontinued for an additional 1 or 2 days, depending on the decrease in renal function. NOACs do not require a preoperative heparin bridge therapy. Emergent or urgent surgeries should preferably be delayed for at least 12 h from the last NOAC intake (better if > 24 h). If surgery cannot be delayed, consider using specific reversal agents, which are idarucizumab for dabigatran and andexanet alfa for rivaroxaban, apixaban, and edoxaban. If these specific reversal agents are not available, consider using prothrombin complex concentrates.

scholarly journals Non-vitamin K Antagonist Oral Anticoagulants and Drug-Food Interactions: Implications for Clinical Practice and Potential Role of Probiotics and Prebiotics

2022 ◽  
Vol 8 ◽  
Author(s):  
Ana Sánchez-Fuentes ◽  
José Miguel Rivera-Caravaca ◽  
Raquel López-Gálvez ◽  
Francisco Marín ◽  
Vanessa Roldán
Keyword(s):  
Clinical Practice ◽  
Vitamin K ◽  
Potential Role ◽  
Therapeutic Option ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Pharmacodynamic Profile ◽  
Potential Interactions

Non-vitamin K antagonist oral anticoagulants (NOACs) are a therapeutic option to prevent stroke in patients with atrial fibrillation (AF). In fact, NOACs have become the recommended choice by international clinical practice guidelines over vitamin K antagonists (VKA), because of their efficacy and safety profile, especially in newly initiated patients. The more predictable pharmacokinetic and pharmacodynamic profile of this family of drugs allows preventing anticoagulation drug monitoring. Furthermore, NOACs have significantly fewer drug and food interactions in comparison with VKAs. Despite this, there are no studies that compare the effects on the quality of anticoagulation of NOACs with the intake of potential interactions drugs of P-glycoprotein and cytochrome P450 (CYP). This review brings an overview of NOACs pharmacokinetics profile and their potential drug-food interactions. We also briefly discuss the potential role of prebiotics and probiotics in patients under therapy with NOACs.

Non–Vitamin K Antagonist Oral Anticoagulants in Coronary Artery Disease

2021 ◽  
Author(s):  
Samer Al Said ◽  
Michael Ellscheid ◽  
Eleftherios T. Beltsios ◽  
Norbert Frey
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vitamin K ◽  
Cardiovascular Events ◽  
Thrombin Generation ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Thromboembolic Events ◽  
Artery Disease

AbstractThe prevention of atherothrombotic events is the primary goal in the treatment of patients with arteriosclerotic disorders. Despite recent improvements in the management of coronary artery disease (CAD) with revascularization techniques and antiplatelet therapy, some patients remain at risk of recurrent cardiovascular events. This could be related to additional thrombin generation. As a result, there has been interest in developing novel therapies to prevent thromboembolic events, targeting thrombin-mediated pathways. These include non–vitamin K antagonist oral anticoagulants (NOACs). This article aims to summarize the recent clinical studies that investigated the role of NOACs in CAD.

Problem-Based Review: Non Vitamin K Antagonist Oral Anticoagulants for the Acute Physician

2015 ◽  
Vol 14 (2) ◽  
pp. 83-89
Author(s):  
Jecko Thachil ◽  
◽  
James Gagg ◽  
Keyword(s):  
Vitamin K ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Coagulation Factors ◽  
Rapid Onset ◽  
Vitamin K Antagonist ◽  
Thrombin Inhibitor ◽  
Oral Formulations ◽  
Direct Anticoagulants ◽  
And Function

Non-vitamin K antagonist oral anticoagulants (NOACs), are direct anticoagulants which inhibit specific coagulation factors and function as anticoagulants. Three NOACs are currently licensed in the United Kingdom: dabigatran, a thrombin inhibitor, and rivaroxaban and apixaban, antagonists of factor Xa. They are set to change the anticoagulant landscape, which was previously ruled by warfarin and heparins. Their advantages including oral formulations, rapid onset and offset of action, predictable pharmacokinetics, no requirement for routine blood monitoring or dose adjustment and very few drug interactions. The increasing use of these drugs means the acute medicine physicians are likely to encounter patients who have been taking them. This article reviews some of the challenging clinical situations in which this may arise.

scholarly journals Management of Bleeding With Non–Vitamin K Antagonist Oral Anticoagulants in the Era of Specific Reversal Agents

Circulation ◽  
2016 ◽  
Vol 134 (3) ◽  
pp. 248-261 ◽  
Author(s):  
Christian T. Ruff ◽  
Robert P. Giugliano ◽  
Elliott M. Antman
Keyword(s):  
Vitamin K ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Reversal Agents
Sign in / Sign up

Export Citation Format

Share Document