Ciraparantag safely and completely reverses the anticoagulant effects of low molecular weight heparin

•Ciraparantag binds to a range of anticoagulants by charge-charge interaction removing them from their target and restoring coagulation.•ciraparantag specifically binds enoxaparin and reverses anticoagulant effect as measured by the whole blood clotting time.•Reversal of anticoagulation is sustained for up to 24 h after a single intravenous injection of ciraparantag.•Ciraparantag is well tolerated without any significant side effects.

Major bleeding with low molecular weight heparin (LMWH) therapy occurs in up to 5% of patients and its anticoagulation is only partially reversed by protamine sulfate. We studied the ability of ciraparantag (PER977), a novel agent that reverses LMWH in preclinical studies, to reverse LMWH in healthy volunteers.MethodsIn this phase 1/2 trial, 4 cohorts of 10 healthy volunteers received escalating doses of ciraparantag (100 to 300 mg) or placebo (8:2 ratio) approximately 4 h after a single subcutaneous dose of enoxaparin, 1.5 mg/kg. Safety, pharmacokinetic and pharmacodynamic effects were assessed.ResultsComplete reversal of enoxaparin anticoagulation, measured by a reduction of whole blood clotting time, was observed in all subjects who received a single ciraparantag dose ranging from 100 mg to 300 mg. The anticoagulation reversal occurred rapidly after bolus injection and persisted for the duration of the study. At 12 h and 24 h, the differences in whole blood clotting time in the treated group compared to placebo were no longer significant, consistent with the decline in enoxaparin concentrations and anticoagulation effects. No procoagulant signals were detected as measured by D-dimer, F1.2, and tissue factor pathway inhibitor levels. Ciraparantag was well tolerated with only transient, minor side effects.ConclusionCiraparantag reverses the whole blood clotting time induced by enoxaparin in a dose related manner and produces no procoagulant signal or deleterious adverse events in doses up to 300 mg.