Episode 2: Factor Xa Inhibitor Reversal Using Andexxa with Gary Peksa

Gary Peksa, PharmD, BCPS
Emergency Medicine Pharmacist

Coagulation factor Xa [recombinant], inactivated-zhzo ( Andexxa )

Mechanism of Action

  • Andexanet alfa binds and sequesters the FXa inhibitors rivaroxaban and apixaban. In addition, andexanet alfa inhibits the activity of Tissue Factor Pathway Inhibitor (TFPI), increasing tissue factor-initiated thrombin generation.
With Factor Xa Inhibitors
With Andexanet
Efficacy Data
Thrombotic Events and Mortality
  • Reference & Additional Readings
    • Connolly SJ et al. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2019 Apr 4;380(14):1326-1335
    • Andexxa (andexanet alfa) [prescribing information]. South San Francisco, CA: Portola Pharmaceuticals, Inc; May 2018.
    • Ghadimi K et al. Andexanet alfa for the reversal of Factor Xa inhibitor related anticoagulation. Expert Rev Hematol 2016; 9: 115-22.
    • Lexi-comp: Andexanet alfa Prescribing Information. Last Updated 6/1/18. Assessed September 27, 2019.
    • FDA Approval Letter – ANDEXXA. May 3, 2018. https://www.fda.gov/downloads/BiologicsBloodVaccines/CellularGeneTherapyProducts/ApprovedProducts/UCM606693.pdf. Assessed September 27, 2019.

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Jimmy L. Pruitt III, PharmD, BCPS, BCCCP

The Pharm So Hard Podcast is a show focused primarily on emergency medicine and hospital pharmacy related topics. To empower healthcare providers with the knowledge and skills they need to provide evidence-based, safe care for critically ill patients.

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