The ANNEXA study was a combination of 2 parallel studies-ANNEXA-A (apixaban) and ANNEXA-R (rivaroxaban)-which were designed to evaluate the efficacy and safety of andexanet for the reversal of factor Xa inhibitors in older, otherwise healthy volunteers.īoth of these randomized, double-blind, and placebo-controlled trials enrolled patients aged between 50 and 75 years. The following is an unbiased assessment of the recently published Anticoagulation Effects of fXA Inhibitors (ANNEXA) study. The reduced anticoagulant activity can be measured by thrombin generation and anti-factor Xa activity.Īndexanet alfa may potentially become the first reversal agent for both apixaban and rivaroxaban.
This would increase factor Xa levels in the body, which in turn would reduce anticoagulant activity. Because only the unbound forms of factor Xa inhibitors apixaban (Eliquis) and rivaroxaban (Xarelto) are active, andexanet alfa would therefore inactivate the factor Xa inhibitor by binding to the active site. 1Īndexanet alfa is a recombinant modified human factor Xa decoy protein that has the ability to bind to factor Xa inhibitors in the active site with high affinity. Idarucizumab (Praxbind) was approved by the FDA in October 2015 for the reversal of the anticoagulant effects of dabigatran for an emergency surgery/urgent procedure or life-threatening or uncontrolled bleeding. Among the new oral anticoagulants (NOACs), only the direct oral thrombin inhibitor dabigatran (Pradaxa) has an approved reversal agent. Currently, there are no FDA-approved agents for the reversal of factor Xa inhibitors.
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