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Pegnivacogin is a 2′-fluoropyrimidine–modified RNA aptamer that directly and selectively inhibits coagulation factor IXa. It is conjugated to a branched methoxypolyethylene glycol (mPEG) molecule to increase its plasma half-life and concentration. Pegnivacogin was developed as part of the REG1 anticoagulation system, which also includes anivamersen, a complementary oligonucleotide reversal agent. The drug was investigated for use in acute coronary syndrome, thrombosis, coronary artery disease, and vascular diseases. Clinical trials showed that pegnivacogin achieves rapid and near-complete inhibition of factor IXa activity in patients with acute coronary syndrome undergoing cardiac catheterization. However, development was discontinued after reports of severe allergic reactions during clinical studies[4][6][8].
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