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The US Food and Drug Administration (FDA) has cleared andexanet alfa (Andexxa) as a reversal agent for the anticoagulant effects of the two most commonly used factor Xa inhibitors in patients with life-threatening or uncontrolled bleeding, manufacturer Portola Pharmaceuticals The antidote is indicated for use in patients who bleed while taking either rivaroxaban (Xarelto; Bayer/Janssen) or apixaban (Eliquis; Bristol-Myers Squibb), but the indication does not cover the other direct factor Xa inhibitors edoxaban (Savaysa; Daiichi Sankyo) and betrixaban (Bevyxxa)—which was Jean Connors, MD (Brigham and Women’s Hospital, Boston, MA), told TCTMD the availability of andexanet alfa is critical because other strategies for reversing bleeding in patients treated with the factor Xa inhibitors are only partially effective.There was no specific reversal agent for this class of drugs until now.
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Its use requires: an astute judgment, and striking a sensitive balance between when to stop Andexanate alfa and to restart OAC (Rivaroxaban and Apixaban).
My approach is: to identify the precise cause of bleed and to fix it as rapidly as possible (many patients have an identifiable cause of such bleeds).
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