The Potential Role for Antidotes in Clinical Practice

%jwplayer%

The MD Magazine Peer Exchange “Novel Anticoagulation Options: Target-Specific Oral Agents and Their Antidotes” features leading physician specialists discussing key topics in anticoagulation therapy, including the clinical characteristics of current and emerging agents and criteria for use in specific patient populations.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Scott Kaatz, DO, MSc, Chief Quality Officer at Hurley Medical Center in Flint, Michigan, and clinical associate professor at Michigan State University
• Seth Bilazarian, MD, clinical and interventional cardiologist at Pentucket Medical and instructor of medicine at Harvard Medical School
• Gerald Naccarelli, MD, Bernard Trabin Chair in Cardiology, professor of medicine and chief of the Division of Cardiology at Penn State University School of Medicine, and associate clinical director at Penn State Heart and Vascular Institute in Hershey, Pennsylvania
• Christian T. Ruff, MD, associate physician in the cardiovascular medicine division at Brigham and Women’s Hospital, and assistant professor of medicine at Harvard Medical School in Boston

These investigational reversal agents will be true antidotes, unlike vitamin K for warfarin, said Ruff. The novel oral anticoagulants prevent so much serious bleeding that the antidotes should not need to be used in the first place, but physicians can have the psychological comfort of knowing that the antidotes exist if they absolutely need to use them. They should not be used in cases of minor bleeding, however.

Also unlike reversing warfarin, reversing the novel oral anticoagulants is not prothrombotic. Kaatz added that, at least with the monoclonal antibody to dabigatran, in cases of normal kidney function, the kidney will clear both the antidote and the anticoagulant, allowing the anticoagulant to be reintroduced right away when needed.

In terms of uptake of the novel oral anticoagulants, Naccarelli believes that approval of their reversal agents will certainly not hurt it, but he doubts it will create an immediate surge in their adoption. Ruff said that people need to realize that the novel oral anticoagulants have been tested in some of the largest clinical trials ever conducted, with more efficacy and safety data than any other type of drug except for possibly the statins, and they were found to be dramatically safer than warfarin. “I think we shouldn’t wait for [the antidote] to use these new drugs. They’re effective as is,” he said.