A paper written by Duke Anesthesiology faculty members, Drs. Kamrouz Ghadimi, Jerrold Levy and Ian Welsby, is cited in a landmark article published in the August 30, 2016 issue of The New England Journal of Medicine, titled “Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors.”
According to Dr. Ghadimi, their cited paper, titled “Andexanet Alfa for the Reversal of Factor Xa Inhibitor Related Anticoagulation,” was one of the first on the topic. He says factor Xa inhibitors and direct thrombin inhibitors, such as Dabigatran, are poised to replace Warfarin which has been the only long term oral anticoagulant for years in patients with non-valvular atrial fibrillation and venous thromboembolic disease. “Vitamin K- antagonists, like Warfarin, have been favored by physicians and practitioners for use because it has had ease of reversal in case of bleeding despite an extensive list of morbid side effects,” says Dr. Ghadimi. “Now, factor Xa inhibitors may also have a potential reversal agent.”
Dr. Ghadimi adds that while the reversal agent, Andexanet Alfa, shows much promise, it remains in the trial stage and awaits approval from the Food and Drug Administration.