Anti-thrombotic agent reversal is possible

The November 2015 issue of Dental Update (Dent Update 2015; 42: 840–854) contains an interesting paper on antiplatelets and anticoagulants (anti-thrombotic agents) and states that ‘worryingly, however, an agent for the reversal of the NOACs in the emergency situation has not yet been developed’ indicating that there are no antagonists to the Newer Oral Anti-Coagulants (NOACs). This is not strictly true and to bring the situation up to date, we report that the US Food and Drug Administration (FDA) has granted approval of the anti-NOAC Praxbind® (idarucizumab),1 a humanized antibody fragment, or Fab, which binds specifically to dabigatran molecules only, neutralizing their anticoagulant effect. Reversal of the dabigatran anticoagulant effects, if needed for emergency surgery/urgent procedures or in life-threatening or uncontrolled bleeding, can be achieved with this agent.2^,3 Furthermore, andexanet alpha can reverse the anticoagulant effects of factor Xa inhibitors, such as apixaban, rivaroxaban, edoxaban or enoxaparin.4^,5 Clinical trials are ongoing on a potential universal antidote, ciraparantag (PER977), which has been shown to bind and reverse unfractionated and low molecular weight heparin, as well as the direct thrombin and Factor X inhibitors.6