Emergency Medicine Literature of Note
Musings on Emergency Medicine, Clinical Informatics, & High-Value Care.
The brave new world of “bleeding that doesn’t stop” is a little closer to ending today. However, this is definitely just the smallest of baby steps in that direction – and hardly as straightforward and simple as the authors’ conclusion: “Andexanet reversed the anticoagulant activity of apixaban and rivaroxaban in older healthy participants within minutes … Continue reading “The Great Reveal of Andexanet Alfa”
Every so often a masterclass performance arises in the medical literature. A performance transcending the boundaries of what was once thought possible. A shining exemplar of human achievement. This is a trial, published in the New England Journal of Medicine, with the following features: And, this is solely the reported mechanisms by which pharma has … Continue reading “The Andexxa Showpiece”
Have you heard the Good News (from Portola) about andexanet?
About two and a half years ago, we were introduced to andexanet alfa (Andexxa), a modified recombinant form of factor Xa designed as a reversal option for factor Xa inhibitors. The mechanism of action is simple: andexanet mimics native factor Xa, providing the various Xa inhibitors (rivaroxaban, apixaban, edoxiban, betrixiban, and enoxaparin) an alternative target. … Continue reading “Disutility, Thy Name is ANEXXA-4”
Just in case you were curious …. Conventional tests useful for ruling out clinically relevant levels contributing to bleeding risk: Dabigatran – a normal Thrombin Time or sensitive activated partial thromboplastin time (aPTT). Factor Xa-inhibitors – None. If you have access to Anti-Xa specialized assays, they can be used to measure the level of activity … Continue reading “What Does the ACC Say About OAC Reversal?”
There’s nothing hotter than idarucizumab, the reversal agent for dabigatran. It’s so hot, the New England Journal of Medicine once published a farcical 91 patient interim analysis of a planned 500 patient enrollment. Now, two years later, we have the full cohort and it’s, well, more of the same, with all the flaws previewed in … Continue reading “Idarucizumab, the Sequel”
Andexanet alfa is the long-awaited antidote for the Factor Xa inhibitors – rivaroxaban, apixaban, edoxaban, and their ilk. This publication, featured at the European Stroke Congress and in the New England Journal of Medicine, is Portola’s latest update regarding its utility. Is it better than their previous update – their failure to receive initial FDA … Continue reading “But Where is the Antidote to the Poison @NEJM?”
The newest study regarding the reversal of the novel oral anticoagulants also concerns the newest of their family – edoxaban, joining a market already occupied by rivaroxaban and apixiban. Yes, it’s just another “me too” drug trying to shoehorn its way into the massive warfarin-replacement market – but, at least, this is useful evidence. 4-Factor … Continue reading “4-Factor Works for Factor Xa Inhibitors”