The Selection of Andexanet Alfa vs. 4‐Factor Prothrombin Complex Concentrate for the Treatment of Life‐Threatening Hemorrhage

Andexanet alfa and 4‐factor prothrombin complex concentrate (4F‐PCC) are used for the reversal of life‐threatening hemorrhages associated with oral Factor Xa inhibitors. Limited studies have examined factors influencing reversal agent selection and time to administration. This retrospective, multicenter cohort study evaluated adult patients who presented with a life‐threatening hemorrhage associated with oral Factor Xa inhibitors (apixaban or rivaroxaban) and were administered either andexanet alfa or 4F‐PCC. The objectives of our study were to analyze whether sociodemographic factors were associated with reversal agent selection, time‐to‐treatment with the selected reversal agent, and patient outcomes. Among 144 patients (50% andexanet alfa and 50% 4F‐PCC), no differences were found in sociodemographic (age, sex, race and ethnicity, insurance, housing status, marital status) or logistical factors (time to reversal agent administration and type of arrival to site hospital) associated with reversal agent selection. There were no differences between andexanet alfa and 4F‐PCC for time to reversal agent administration, mortality, mechanical ventilation, length of stay, and thromboembolic events. Factors associated with a longer time to reversal agent administration included patients who were transferred from an outside hospital (RR: 1.27; 95% CI: 1.00, 1.61), patients who received blood products (RR: 1.30; 95% CI: 1.01, 1.68), and patients who were Black compared to non‐Hispanic White (RR: 1.34; 95% CI: 1.02, 1.76) after adjusting for age, sex, reversal agent selection (andexanet vs. 4F‐PCC), bleeding event type related to Factor Xa inhibitors, insurance, and marital status. In conclusion, there were no statistically significant disparities found in sociodemographic factors associated with the selection of andexanet alfa and 4F‐PCC.