Evidence map›Paper›PMID 32231703›Full record

ReviewAdvances in hematology2020

An Update on the Reversal of Non-Vitamin K Antagonist Oral Anticoagulants.

Mark Terence P Mujer, Manoj P Rai, Varunsiri Atti, Ian Limuel Dimaandal, Abigail S Chan, Shiva Shrotriya, Krishna Gundabolu, Prajwal Dhakal

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Advances in hematology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Antithrombotic prophylaxis following total hip arthroplasty: a level I Bayesian network meta-analysis.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2024
    Pooled it
  2. Optimal management of cardiac surgery patients using direct oral anticoagulants: recommendations for clinical practice.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2023
    Pooled it
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  11. Is triple antithrombotic therapy a safe option in patients with AF who receive drug-eluting stents?: a review article.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2023
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  16. Dry Needling and Antithrombotic Drugs.Pain research & management · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Mark Terence P MujerDepartment of Medicine, Michigan State University, East Lansing, MI, USA.
Manoj P RaiDepartment of Medicine, Michigan State University, East Lansing, MI, USA.ORCID https://orcid.org/0000-0003-4162-033X
Varunsiri AttiDepartment of Medicine, Michigan State University, East Lansing, MI, USA.
Ian Limuel DimaandalDepartment of Internal Medicine, University of Connecticut, Farmington, CT, USA.
Abigail S ChanDepartment of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA.ORCID https://orcid.org/0000-0002-8468-2162
Shiva ShrotriyaDepartment of Medicine, Michigan State University, East Lansing, MI, USA.
Krishna GundaboluDivision of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Prajwal DhakalDivision of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs) include thrombin inhibitor dabigatran and coagulation factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and betrixaban. NOACs have several benefits over warfarin, including faster time to the achieve effect, rapid onset of action, fewer documented food and drug interactions, lack of need for routine INR monitoring, and improved patient satisfaction. Local hemostatic measures, supportive care, and withholding the next NOAC dose are usually sufficient to achieve hemostasis among patients presenting with minor bleeding. The administration of reversal agents should be considered in patients on NOAC's with major bleeding manifestations (life-threatening bleeding, or major uncontrolled bleeding), or those who require rapid anticoagulant reversal for an emergent surgical procedure. The Food and Drug Administration (FDA) has approved two reversal agents for NOACs: idarucizumab for dabigatran and andexanet alfa for apixaban and rivaroxaban. The American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS) have released an updated guideline for the management of patients with atrial fibrillation that provides indications for the use of these reversal agents. In addition, the final results of the ANNEXA-4 study that evaluated the efficacy and safety of andexanet alfa were recently published. Several agents are in different phases of clinical trials, and among them, ciraparantag has shown promising results. However, their higher cost and limited availability remains a concern. Here, we provide a brief review of the available reversal agents for NOACs (nonspecific and specific), recent updates on reversal strategies, lab parameters (including point-of-care tests), NOAC resumption, and agents in development.

Identifiers

PMID32231703
PMCPMC7097770

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.