Key result
Andexanet alfa, a reversal agent for factor Xa inhibitors, was highlighted for reducing median anti-Xa activity by 92% and achieving excellent or good hemostasis in 82% of patients with serious bleeding.
Why the study?
Direct oral anticoagulants carry lower bleeding rates than vitamin K antagonists, but life-threatening bleeding still occurs, necessitating reversal agents.
Does andexanet alfa improve hemostasis in patients with serious bleeding while receiving factor Xa inhibitors?
Does andexanet alfa improve hemostasis in patients with serious bleeding while receiving factor Xa inhibitors?
Andexanet alfa is an effective reversal agent for factor Xa inhibitors, demonstrating significant reductions in anti-Xa activity and high rates of clinical hemostasis in patients with serious bleeding.
May support andexanet alfa for factor Xa inhibitor bleeds; leaves open need for randomized outcome trials.
Direct oral anticoagulants are associated with lower rates of bleeding than vitamin K antagonists, but life-threatening bleeding still occurs. Andexanet alfa is a catalytically inactive recombinant modified human factor Xa molecule that reverses the anticoagulant effect of direct and indirect acting factor Xa inhibitors. In the ANNEXA-4 study, treatment with andexanet was associated with a 92% reduction in median anti-Xa activity levels and excellent or good hemostasis in 82% of patients presenting with serious bleeding while receiving apixaban or rivaroxaban. In this review, we discuss the burden of bleeding in anticoagulated patients and the need for reversal agents, review the mechanism of action of andexanet and critically evaluate the evidence for its efficacy and safety.
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Abdulrehman et al. (2019) conducted a review in Serious bleeding in patients receiving factor Xa inhibitors. Andexanet alfa was evaluated on Anti-Xa activity levels and hemostasis. Andexanet alfa, a reversal agent for factor Xa inhibitors, was highlighted for reducing median anti-Xa activity by 92% and achieving excellent or good hemostasis in 82% of patients with serious bleeding.
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