In the present study, we report different aspects of anticoagulation therapy in Iran, including the type of anticoagulants which are prescribed, clinical indications, and available laboratory monitoring tests.Īnticoagulant therapy is a common practice in Iran, mostly prescribed by cardiologists, hematologists, oncologists, internists, anesthesiologists, and gynecologists. Direct thrombin inhibitors (DTIs) and factor Xa inhibitors (FXIs), known as direct oral anticoagulants (DOACs), have a growing role in the management of thromboembolic disorders ( 9). Heparin, including unfractionated heparin (UFH) and low molecular weight heparin (LMWH), is another commonly used anticoagulant worldwide, but regular monitoring and several potentially severe adverse effects, such as hemorrhage and heparin induced thrombocytopenia (HIT), are the main disadvantages of such parenterally administered anticoagulants ( 8). Although warfarin is cheap, and widely available, it has a narrow therapeutic window, several side effects, and requires regular and close laboratory monitoring ( 7). Warfarin, the most well-known VKAs, is the commonly used anticoagulants for management of thrombosis and related complications ( 6). Vitamin K antagonists (VKAs) and heparin were, in the recent past, the only available drugs for anticoagulation therapy in thromboembolic disorders ( 5). On the other side, with the advent of new anticoagulants, prophylaxis, and management of thrombotic events, as a leading cause of morbidity and mortality, has both improved significantly ( 3, 4). Advancements in recombinant coagulation factors synthesis have made a breakthrough in the management of the bleeding disorders and has made significant changes in affected patients’ life quality ( 2). Management of thrombosis and bleeding has improved significantly in recent years. Bleeding disorders are associated with a high rate of morbidity and mortality ( 1). Thrombosis and bleeding are two sides of the double-edged sword of hemostasis. Received: 16 July 2019 Accepted: 29 October 2019 Published: 11 December 2019.

Keywords: Anticoagulation therapy thrombosis warfarin heparin direct oral anticoagulants

The use of the antidote is increasing due to the safety and efficacy profile of rivaroxaban and apixaban compared with warfarin and enoxaparin to treat and prevent conditions such as pulmonary embolism, stroke and venous thromboembolism, according to the press release.Īs Cardiology Today previously reported, the antidote was approved by the FDA last year, which was based on results from the phase 3 ANNEXA studies.Akbar Dorgalaleh 1, Peyman Beigi 2, Mahdi Pakjoo 2, Masoud Eslami 2, Pegah Kiyamehr 1, Sanaz Khaseb 2, Saba Seifpour 2, Shadi Tabibian 1, Majid Naderi 3, Ali Dabbagh 4, Nader Safarian 5, Soudabeh Hosseini 1ġ Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran Ģ Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University (TMU), Tehran, Iran ģ Department of Pediatrics Hematology and Oncology, Ali Ebn-e Abitaleb Hospital Research Center for Children and Adolescents Health (RCCAH), Zahedan University of Medical Sciences, Zahedan, Iran Ĥ Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ĥ Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IranĬontributions: (I) Conception and design: A Dorgalaleh (II) Administrative support: None (III) Provision of study materials or patients: A Dorgalaleh, P Beigi, A Dabbagh, N Safarian (IV) Collection and assembly of data: P Beigi, M Pakjoo, M Eslami, P Kiyamehr, S Khaseb, S Seifpour, S Tabibian, M Naderi, A Dabagh, N Safarian, S Hosseini (V) Data analysis and interpretation: A Dorgalaleh, P Beigi (IV) Manuscript writing: All authors (V) Final approval of manuscript: All authors. Portola Pharmaceuticals announced that the FDA approved its Prior Approval Supplement for the second generation of andexanet alfa, allowing for its broad commercial launch in the U.S.Īndexanet alfa (Andexxa, Portola) is an antidote for patients treated with rivaroxaban (Xarelto, Janssen) or apixaban (Eliquis, Bristol-Myers Squibb) who require anticoagulation reversal due to uncontrolled or life-threatening bleeding, according to a press release from the company.

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Enoxaparin antidote