In healthy volunteers, 50–75 years of age, and treated with apixaban or rivaroxaban, bolus administration of andexanet alfa reduced anti-FXa activity and restored thrombin generation within 2–5 minutes. 2,3 In patients with nonvalvular atrial fibrillation, NOACs have been reported to significantly reduce stroke or systemic embolic events compared to warfarin (relative risk 0.81, 95% confidence interval 0.73–0.91 p2–3 times the half-lives after last dose of rivaroxaban (t ½ 5–13 hours) or apixaban (t ½ 13 hours), seems questionable. FXa inhibitors are widely used for stroke prevention in patients with nonvalvular atrial fibrillation, 1 and for the treatment and prevention of deep vein thrombosis and pulmonary embolism. The factor Xa (FXa) inhibitors apixaban, rivaroxaban and edoxaban, together with the thrombin inhibitor dabigatran, are collectively referred to as non-vitamin K antagonist (or direct) oral anticoagulants (NOACs). KeywordsĪndexanet alfa, factor Xa inhibitors, major bleeding, reversal agent Article:
A practical tool to direct appropriate use of andexanet alfa is proposed. Assessment of potentially suitable patients by a multidisciplinary team, use according to the institutional protocol, and central storage, all contribute to proper use of andexanet alfa. Unnecessary usage should be prevent ed as this may compromise patient safety. This review will discuss andexanet alfa’s mode of action, indication for use and efficacy, with a focus on its appropriate use in clinical practice. Recently, however, the United States Food and Drug Administration and the European Medicines Agency approved andexanet alfa for reversal of anticoagulation in patients treated with rivaroxaban or apixaban who have life-threatening or uncontrolled bleeding. Despite their demonstrated safety, implementation of FXa inhibitors in clinical practice may have been limited by the lack of a specific antidote. Nevertheless, bleeding remains a feared complication of any anticoagulant therapy. Compared to warfarin, individual FXa inhibitors are associated with a lower risk of major bleeding. Factor Xa (FXa) inhibitors are widely used for stroke prevention in patients with nonvalvular atrial fibrillation, and for the treatment and prevention of deep venous thrombosis and pulmonary embolism.
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