Key result
Andexanet alfa infusion for apixaban reversal is linked to acute STEMI during active therapy.
Why the study?
Thrombotic events after andexanet alfa typically occur 6 to 30 days post-infusion, but occurrence during active infusion had not been described.
Case Report (n=1)
This case illustrates that acute thrombotic events, specifically STEMI, can occur during the active infusion of the factor Xa reversal agent andexanet alfa, underscoring the need for vigilant monitoring during administration.
May warrant close monitoring for STEMI during andexanet alfa infusion; leaves open whether thrombotic risk extends to active therapy.
Now withdrawn from the US market, andexanet alfa was initially approved by the FDA in 2018 to reverse life-threatening bleeds associated with factor Xa (FXa) inhibitors, specifically apixaban and rivaroxaban. Observed effects of andexanet alfa include a reduction in anti-FXa activity resulting in hemostatic efficacy. However, thrombotic events including myocardial infarction and deep venous thrombosis, typically occurring 6 to 30 days after infusion, have also been observed. This case presents the first known patient to develop an ST-segment elevation myocardial infarction while actively receiving infusion of andexanet alfa, which was an approved therapy at the time of the patient's treatment.
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Dalal et al. (2026) conducted a case report in Gastrointestinal bleeding on apixaban (n=1). Andexanet alfa was evaluated on Development of ST-segment elevation myocardial infarction. Andexanet alfa infusion for apixaban reversal was associated with the development of an acute ST-segment elevation myocardial infarction during active therapy.
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