Background: While andexanet has been approved for reversal of the anti-Xa inhibitors apixaban and rivaroxaban, few studies have described important aspects of real-world clinical use such as dosing, timing in relationship to last dose of oral anticoagulant, and outcomes related to safety and effectiveness.
Aims: Describe use and 30-day patient outcomes of andexanet for anti-Xa reversal at an academic medical center.
Methods: This was a case series of adult patients who were administered andexanet for anti-Xa inhibitor reversal.
Results: We identified 18 orders for andexanet between 2018-2022; 15 were administered. Median patient age was 68 (interquartile range: 58-75), 60% were female, 80% were white, and 66% were receiving apixaban. The most common indication for andexanet was intracranial bleeding (73.3%). Last dose of anti-Xa inhibitor was < 8 hours in 2 patients (13.3%), unknown in 5 (33.3%), and >8 hours in 8 (53.3%). Per dosing guidelines, three patients on rivaroxaban were administered incorrect doses (too low, too high, and incorrect infusion rate, respectively). Infusion times ranged from 39 minutes to 12 hours, with a median time of 2 hours. Seven patients received ≥1 additional reversal/hemostatic agent: prothrombin complex concentrate (5, 33.3%), desmopressin (2, 13.3%), fresh frozen plasma (1, 6.7%), and phytonadione (1, 6.7%). Three patients received an agent at an outside hospital. Five patients experienced adverse events within 30 days: 4 deaths (26.7%) and 1 stroke (6.7%). All adverse events occurred within 8 days of andexanet administration.
Conclusion(s): Many patients received inappropriate administration of andexanet and received additional reversal/hemostatic agents. The last dose of anti-Xa inhibitor was administered greater than 8 hours prior to factor Xa reversal with andexanet in over half of patients. These findings suggest that development of, and adherence to, administration guidelines are required to ensure safe and appropriate administration of andexanet alfa.
To cite this abstract in AMA style:Jones A, Brewster A, Jolley M, Saunders J, Wilson A, Vazquez S, Crowther M, Witt D. Real-world Use of Andexanet Alfa for Anti-Xa Inhibitor Reversal: A Case Series [abstract]. https://abstracts.isth.org/abstract/real-world-use-of-andexanet-alfa-for-anti-xa-inhibitor-reversal-a-case-series/. Accessed August 16, 2022.
« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/real-world-use-of-andexanet-alfa-for-anti-xa-inhibitor-reversal-a-case-series/