![]() ![]() Direct thrombin and factor Xa inhibitors provide anticoagulant efficacy similar to that of warfarin. apixaban, rivaroxaban, edoxaban, and betrixaban), these newer anticoagulants are increasingly being used in lieu of warfarin. dabigatran) and factor Xa inhibitors (e.g. With the emergence of more convenient anticoagulants, such as direct thrombin inhibitors (e.g. However, warfarin has several limitations, including its narrow therapeutic index, the need for frequent blood testing, and the potential for multiple drug interactions. Warfarin (an oral vitamin K antagonist) has long been the mainstay for the treatment and prevention of thromboembolism, as well as for stroke prevention in atrial fibrillation. Thromboembolism is a leading cause of preventable hospital death, with elderly patients being at a particularly high risk. With the known increased risk of thromboembolic events following andexanet alfa treatment, anticoagulant therapy should be resumed as soon as medically appropriate. The tolerability profile of andexanet alfa in patients is generally similar to that reported of other approved anticoagulation reversal agents. ![]() In adults with major bleeding associated with the use of apixaban or rivaroxaban, intravenous administration of andexanet alfa effectively and rapidly reduces anti-factor Xa levels, with reduced levels being maintained during continued treatment. Andexanet alfa acts as a decoy and competes with endogenous factor Xa to bind factor Xa inhibitors, thereby reversing the anticoagulant effects of factor Xa inhibitors, and restoring the activity of endogenous factor Xa. Andexanet alfa (Andexxa ®), a first-in-class recombinant modified factor Xa protein, is currently the only specific agent available to reverse life-threatening or uncontrolled bleeding with the factor Xa inhibitors apixaban and rivaroxaban. ![]()
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