Characteristics of DOAC-specific reversal agents
| . | Ciraparantag . | Idarucizumab . | Andexanet alfa . |
|---|---|---|---|
| Anticoagulants indicated for reversal | Direct thrombin inhibitors, factor Xa inhibitors, heparins | Dabigatran | Factor Xa inhibitors (rivaroxaban, apixaban, edoxaban, enoxaparin) |
| Mechanism of action | Reported to bind anticoagulants via noncovalent hydrogen bonds and charge-charge interactions | Monoclonal antibody fragment to bind dabigatran | Inactive form of factor Xa to bind inhibitors |
| Suggested administration | Phase 2 study used 100-300 mg single intravenous dose | Total of 5 g given as two 2.5-g 50 mL boluses within 15 minutes of each other | 800 mg bolus and 960 mg infusion over 2 h; patients who take apixaban or rivaroxaban more than 7 hours before andexanet administration: 400 mg bolus and 480 mg infusion over 2 hours |
| Time to onset | Within 10-30 minutes | Within minutes (between vials in REVERSE-AD31 ) | Within 2-5 minutes |
| . | Ciraparantag . | Idarucizumab . | Andexanet alfa . |
|---|---|---|---|
| Anticoagulants indicated for reversal | Direct thrombin inhibitors, factor Xa inhibitors, heparins | Dabigatran | Factor Xa inhibitors (rivaroxaban, apixaban, edoxaban, enoxaparin) |
| Mechanism of action | Reported to bind anticoagulants via noncovalent hydrogen bonds and charge-charge interactions | Monoclonal antibody fragment to bind dabigatran | Inactive form of factor Xa to bind inhibitors |
| Suggested administration | Phase 2 study used 100-300 mg single intravenous dose | Total of 5 g given as two 2.5-g 50 mL boluses within 15 minutes of each other | 800 mg bolus and 960 mg infusion over 2 h; patients who take apixaban or rivaroxaban more than 7 hours before andexanet administration: 400 mg bolus and 480 mg infusion over 2 hours |
| Time to onset | Within 10-30 minutes | Within minutes (between vials in REVERSE-AD31 ) | Within 2-5 minutes |