Kcentra is a four factor PCC and will add Factor VII, Factor IX, Factor X, and prothrombin Slide 8: Profilnine is a 3 factor PCC and will add Factor IX, Factor X, and prothrombin
Using the same coagulation cartoon, the specific reversal strategies or factor supplements such as PCCs will be detailed.Īndexxa targets Factor Xa DOACs and factor XaįEIBA will add mostly factor VIIa but also factor IX, Factor X, and factor II prothrombin The factor Xa DOAC, includes rivaroxaban, apixaban, edoxaban and betrixaban and inhibit factor Xa in the common pathway. Dabigatran, currently the only direct thrombin DOAC, inhibits thrombin or factor IIa. Slide 6:Īs a reminder, the DOAC targets are represented in this cartoon of the simplified coagulation cascade. Of particular note, that safe or acceptable DOAC thresholds or levels for emergent invasive procedures or thrombolysis is based on limited data. Additionally, it has been proposed that demonstrable DOAC levels should be present prior to using reversal agents. The clinical indications for DOAC reversal include hemorrhage or major bleeding, especially into critical organs or spaces, the need for emergent invasive procedures, or reducing drug exposure prior to thrombolysis in acute thrombotic stroke. However, the use of activated and nonactivated PCCs are still being used for DOAC reversal, although primarily limited to factor Xa DOACs. In 2018, Andexxa was FDA approved as a specific reversal agent for rivaroxaban and apixaban. In 2015, Praxbind was FDA approved as a specific reversal agent for dabigatran. For factor Xa DOACs, the reversal strategies included activated factor VIIa, prothrombin complex concentrates or PCCs, in both activated and inactivated forms. Other traditional means of reversing anticoagulants, such as fresh frozen plasma or activated factor VIIa had limited efficacy. To neutralize dabigatran, activated charcoal could be used if recently ingested, or dialysis to physically remove drug. In the early years, there were no specific reversal agents or antidotes for these drugs. The next several years, factor Xa DOAC, including rivaroxaban and apixaban were approved for use. The first DOAC, dabigatran or Pradaxa, was approved for use in the US in 2010. This session is a joint effort between the American Association for Clinical Chemistry (AACC) and the North American Specialized Coagulation Laboratory Association (NASCOLA) Slide 3: Welcome to this Pearl of Laboratory Medicine on “ Reversal strategies for DOACs: Laboratory role?.” This program was created with Dr Dot Adcock, the Chief Medical Officer and SVP of LabCorp. I currently serve as a volunteer with UC Davis Thrombosis & Hemostasis Center after my retirement in 2017 from the university health system as the senior Clinical Laboratory Scientist in special coagulation.
0 kommentar(er)
