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Reversal Agents for Direct Oral Anticoagulants

Understanding New and Upcoming Options

Rogers, Kelly C. PharmD, FCCP; Shelton, Melanie P. PharmD; Finks, Shannon W. PharmD, FCCP, BCPS–AQ Cardiology

doi: 10.1097/CRD.0000000000000118
New Therapy Update
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Direct oral anticoagulants (DOACs), originally developed as an alternative for vitamin K antagonists, are shifting the landscape of antithrombotic therapy. DOACs such as dabigatran, rivaroxaban, apixaban, and edoxaban offer enhancements in safety, convenience, and efficacy compared with warfarin. However, as choices for oral anticoagulation therapy have increased, so has the need for effectual antidotes before urgent surgical procedures and for the reversal of serious adverse events caused by DOACs. To date, one antidote has been FDA approved in the United States for the reversal of dabigatran, and two antidotes are undergoing phase 2and 3clinical trials. This review will summarize currently available and developing data for DOAC antidotes: idarucizumab, exanet alfa, and ciraparantag.

From the *Clinical Pharmacy, College of Pharmacy, University of Tennessee, Memphis, TN; and Med Communications Inc., Memphis, TN; and Clinical Pharmacy, College of Pharmacy, University of Tennessee, Memphis, TN.

Disclosure: The authors declare no conflicts of interest to report.

Correspondence: Shannon W. Finks, PharmD, FCCP, BCPS, Professor of Clinical Pharmacy, College of Pharmacy, University of Tennessee, 881 Madison Avenue, Room 459, Memphis, TN 38163. E-mail: sfinks@uthsc.edu.

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