John Libbey Eurotext

Annales de Biologie Clinique

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Strategies of neutralization of the direct oral anticoagulants effect: review of the literature Volume 77, issue 1, Janvier-Février 2018

Authors
1 Université Paris-Descartes, Sorbonne-Paris-Cité, Paris, France
2 Inserm UMR 1140, Faculté de pharmacie, Paris, France
3 Service d’hématologie biologique, Hôpital Cochin, AP-HP, Paris, France
4 Service d’hématologie biologique, CHU Pontchaillou, Rennes, France
5 CIC-Inserm 1414, Université de Rennes 1, France
* Tirés à part
  • Key words: xabans, dabigatran, antidote, pro-hemostatic agent, coagulation
  • DOI : 10.1684/abc.2018.1400
  • Page(s) : 67-78
  • Published in: 2018

Many neutralizing agents of anticoagulant effect of factor Xa or thrombin inhibitors (xabans and dabigatran, respectively) have been developed since the commercialization of direct oral anticoagulants (DOAC) in 2008. Idarucizumab is a specific antidote of dabigatran commercialised since 2016. An antidote of xabans, andexanet-α, was very recently approved by the Food and Drug Administration (FDA). Other antidotes of DOAC are under pre-clinical or clinical development; the most advanced being the aripazine in addition to γ-thrombine S195A and GDFXa-α2M complex. Prothrombin complex concentrates activated or not, are part of the pro-hemostatic agents suggested for DOAC handling in case of haemorrhage or preceeding urgent surgery or invasive procedures. Other pro-hemostatic agents (FXaI16L, FX (a)-C, superFVa) are in pre-clinical stage. The efficacy of these different agents in DOAC reversal and mortality reduction is still controversal in the light of the sparse results of in vitro, ex vivo, pre-clinical and clinical studies.