|
NOAC |
Trade name |
Peak level |
Action site (4) |
Lower ICH rate than Warfarin (5) |
antidote |
Reversal by Hemodialysis |
other |
|
Dabigatran (2010) |
Pradaxa 150 mg/cap BID, 75mg BID when
CCr< 30 [1] |
0.5—2 hrs. |
Thrombin (IIa) |
yes |
Idarucizumab 2.5gm stat and BID. (6) |
Helpful (10) |
Easily GI bleeding |
|
Rivaroxaban |
Xarelto 20mg/tab QD. 15mg QD when
CCr<50 [1] |
2—4 hrs |
Xa |
yes |
andexanet alfa and four factor
prothrombin complex concentrate (4F-PCC)(7*, 8) |
will not be dialyzable [11] |
Easily GI bleeding |
|
Apixaban |
Eliquis 5 mg/tab BID, 2.5 mg BID when
> 2 risk factors. [Age ≥ 80; Weight ≤ 60; Serum Creatinine ≥ 1.5 mg/dL] [1] |
2—4 hrs. (2) |
Xa |
yes |
andexanet alfa and four factor
prothrombin complex concentrate (4F-PCC)(7*, 8) |
unclear whether dialysis would be useful [11]. |
Less significant bleeding, Hazard
ratio=0.5 (12) |
|
Edoxaban |
Lixiana 60 mg/tab QD, 30mg QD when CCr<30 [1] |
1—2hrs (3) |
Xa |
yes |
four-factor prothrombin complex
concentrate (4F-PCC) at 50 IU/kg (8, 9) |
unclear whether edoxaban can be dialyzed [11]. |
Less significant bleeding, Hazard ratio=0.83 (12) |
* N=56, in setting of ICH, hemostatic efficacy occurred in 64.7% of patients receiving andexanet alfa and 54.8% of receiving 4F-PCC. Thirty-day all-cause mortality was 45.2% for 4F-PCC and 30% for andexanet alfa(7).
GI = gastro-intestinal.
References
1.
Hu A, Niu J, Winkelmayer WC.
Oral Anticoagulation in Patients With End-Stage Kidney Disease on Dialysis and
Atrial Fibrillation. Semin Nephrol. 2018 Nov;38(6):618-628.
2.
https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/65848
3.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608015/
4.
Polzin A, Dannenberg L, Thienel
M, Orban M, Wolff G, Hohlfeld T, Zeus T, Kelm M, Petzold T. Noncanonical
Effects of Oral Thrombin and Factor Xa Inhibitors in Platelet Activation and
Arterial Thrombosis. Thromb Haemost. 2021 Feb;121(2):122-130.
5.
Katsanos AH, Schellinger PD,
Köhrmann M, Filippatou A, Gurol ME, Caso V, Paciaroni M, Perren F, Alexandrov
AV, Tsivgoulis G. Fatal oral anticoagulant-related intracranial hemorrhage: a
systematic review and meta-analysis. Eur J Neurol. 2018 Oct;25(10):1299-1302.
6.
Lindeman E. Målstyrd
antidotterapi vid reversering av dabigatran [Goal-directed administration of
antidote for reversal of dabigatran anticoagulation]. Lakartidningen. 2017 Dec
5;114:ESF3. Swedish.
7.
Vestal ML, Hodulik K,
Mando-Vandrick J, James ML, Ortel TL, Fuller M, Notini M, Friedland M, Welsby IJ.
Andexanet alfa and four-factor prothrombin complex concentrate for reversal of
apixaban and rivaroxaban in patients diagnosed with intracranial hemorrhage. J
Thromb Thrombolysis. 2021 Jun 8. doi: 10.1007/s11239-021-02495-3.
8.
Carpenter E, Singh D, Dietrich
E, Gums J. Andexanet alfa for reversal of factor Xa inhibitor-associated
anticoagulation. Ther Adv Drug Saf. 2019 Nov 26;10:2042098619888133.
9.
Galbiati G. Successful Cerebral
Hemorrhage Control with Prothrombin Complex Concentrate in a Patient on
Edoxaban Therapy: A Case Report. J Blood Med. 2020 Jan 30;11:35-38.
10. Awad NI, Brunetti L, Juurlink DN. Enhanced elimination of dabigatran
through extracorporeal methods. J Med Toxicol. 2015 Mar;11(1):85-95.
11. Crowther M, Crowther MA. Antidotes for novel oral anticoagulants:
current status and future potential. Arterioscler Thromb Vasc Biol. 2015 Aug;35(8):1736-45.
12. https://jtp.taiwan-pharma.org.tw/139/013.html
edited by Yu-Jang Su Aug, 17, 2021.
