Novel Oral Anticoagulants (NOAC's)

• Thrombin inhibitors
  • dabigatran (Pradaxa)
• Coagulation Factor Xa inhibitors (notice they all have "Xa" in their names)
  • rivaroxaban (Xarelto)
  • apixaban (Eliquis)
  • edoxaban (Savaysa)
  • betrixaban (Bevyxxa)

Reversal Agents

• Idarucizumab (Praxbind)
  • Only for reversing dabigatran
  • Monocloncal antibody with much higher affinity for the thrombin binding site than thrombin so get near-irreversible binding until the complex is renally excreted
• Andexanet alfa (Andexxa)
  • Recombinant coagulation factor Xa
  • Technically only approved for apixaban and rivaroxaban but reading how to use it, it would seem it could be used for edoxaban and betrixaban, but it would be off-label for reversing these agents.
• 4-factor prothrombin complex concentrate (4F-PCC, 4-PCC) (Kcentra, Feiba)
  • concentrate of factors II, VII, IX, X (in common numerals 2, 7, 9, 10)
  • Kcentra may also have proteins C and S, not sure about Feiba
  • replacement of factor X (which the body activates) is thought to at least partially reverse the activity of anti-Xa agents
• 3-factor prothrombin complex concentrate (3F-PCC, 3-PCC)
  • I'm not sure this is actually available
  • contains factors II, IX, and X (in common numerals 2, 9, 10)
  • has much less, if any, factor VII, so is less effective activating the replacement factor X
• ciraparantag
  • NOT YET AVAILABLE
  • Supposedly reverses all NOACs
  • "Directly binds to anticoagulants." Hmmm, so does it also bind to warfarin (Coumadin)? I will read about this medication if and when it becomes available.

Notes

• FFP and cryo contain very little factor X and so do not reverse the factor Xa inhibitors (rivaroxaban, apixaban, edoxaban, betrixaban)
• protamine sulfate does not have any effect on NOACs
• vitamin K does not have any effect on NOACs