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Is there a role for the laboratory monitoring in the management of specific antidotes of direct oral anticoagulants? | LitMetric

Is there a role for the laboratory monitoring in the management of specific antidotes of direct oral anticoagulants?

Thromb Res

Paris Cité University, INSERM, Innovative Therapies in Haemostasis, F-75006 Paris, France; Laboratory of Hematology, Lariboisière hospital, AP-HP. Nord, F-75010 Paris, France. Electronic address:

Published: May 2024

AI Article Synopsis

  • More people are taking a type of medicine called DOAC, and sometimes they need immediate help if they bleed a lot or need surgery.
  • There are special medicines called antidotes like idarucizumab for dabigatran and andexanet alfa for other DOACs to stop the effects quickly.
  • It's important to measure how much DOAC is in a person's blood to know if they need these antidotes, but sometimes the tests can be confusing after using the antidotes, so more research is needed on how to manage this well.

Article Abstract

Given the growing number of patients receiving direct oral anticoagulant (DOAC), patients requiring rapid neutralization is also increasing in case of major bleedings or urgent surgery/procedures. Idarucizumab is commercialized as a specific antidote to dabigatran while andexanet alfa has gained the Food and Drug Administration and the European Medicines Agency approval as an oral anti-factor Xa inhibitors antidote. Other antidotes or hemostatic agents are still under preclinical or clinical development, the most advanced being ciraparantag. DOAC plasma levels measurement allows to appropriately select patient for antidote administration and may prevent unnecessary prescription of expensive molecules in some acute clinical settings. However, these tests might be inconclusive after some antidote administration, namely andexanet alfa and ciraparantag. The benefit of laboratory monitoring following DOAC reversal remains unclear. Here, we sought to provide an overview of the key studies evaluating the safety and efficacy of DOAC reversal using the most developed/commercialized specific antidotes, to discuss the potential role of the laboratory monitoring in the management of patients receiving DOAC specific antidotes and to highlight the areas that deserve further investigations in order to establish the exact role of laboratory monitoring in the appropriate management of DOAC specific antidotes.

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Source
http://dx.doi.org/10.1016/j.thromres.2024.04.005DOI Listing

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