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

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.

• 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.

Related Foam Posts

• https://emcrit.org/emcrit/issues-andexanet/
• https://first10em.com/andexanet-alfa/
• http://www.emlitofnote.com/?p=4384
• https://www.stemlynsblog.org/jc-reversal-of-noacs-andexanet/
• http://www.emdocs.net/reversal-of-anticoagulation-an-update/

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