Association Between On-Site Pharmacist Involvement in Andexanet Alfa Preparation and Time to Andexanet Alfa Administration in an Emergency and Critical Care Center:

This is the authors' abstract. We don't add key points for this paper.

Andexanet alfa requires complex preparation because the dose varies with the type dose, and the time since the last dose of factor Xa inhibitor, requiring reconstitution of multiple vials for bolus administration and continuous infusions. Its infrequent use may limit staff proficiency, potentially delaying treatment initiation. This study investigated the association between pharmacist involvement in andexanet alfa preparation and the time to treatment initiation in an emergency and critical care center. This single-center retrospective study included patients who received andexanet alfa for severe bleeding between November 2022 and March 2026. Patients whose drug preparation involved a pharmacist were assigned to the intervention group, whereas those managed by physicians and nurses comprised the non-intervention group. The primary outcome was the time from hospital arrival to treatment initiation (Time 1). Secondary outcomes were the time to computed tomography (CT) (Time 2) and the time from CT to treatment initiation (Time 3). Seventeen patients were included (intervention, n = 8; non-intervention, n = 9). The median Time 1 was 52 minutes shorter in the intervention group (62 vs 114 min; P = 0.075; δ = -0.528). No significant differences were observed in Time 2 or 3, although median Time 3 was 20 min shorter in the intervention group ( P = 0.193; δ = -0.389). A sensitivity analysis restricted to intracranial hemorrhage (n = 15) showed similar trends. Although not statistically significant, pharmacist involvement in drug preparation may be associated with a shorter time to andexanet alfa administration, warranting further investigation.