Game Change in the World of Atrial Fibrillation

The absence of an antidote may soon disappear as a reason to avoid prescribing a novel oral anticoagulant to patients with atrial fibrillation, based on promising phase III trial results.

The very good news in the world of atrial fibrillation is the recent announcement of phase 3 trial results that showed andexanet alfa provided rapid and near complete reversal (≈94%) of the factor Xa inhibitor apixaban. A similiar trial with rivaroxaban is under way as is a trial to gain FDA approval for the direct thrombin inhibitor antidote idarucizumab. Absence of a reliable reversal agent is believed to be an impediment to wider acceptance of the novel oral anticoagulants NOAC). In other AF news, the FDA has just approved edoxaban, the fourth NOAC available in the United States.