4 A targeted reversal agent, coagulation factor Xa (recombinant), inactivated-zhzo (AndexXa®), formerly known as andexanet alfa, was recently approved by the FDA.

1,2, Neurocritical Care Society guideline for reversal of antithrombotics in intracranial hemorrhage (ICH) suggest to administer 4-factor or activated PCC at a dose of 50 units/kg for patients with ICH taking factor Xa inhibitors (low quality evidence). Drug-specific anti-Xa levels for rivaroxaban and apixaban are not FDA-approved or widely available, leading to difficulty in measuring and monitoring their anticoagulation effect. Historically, strategies for the treatment of bleeding patients taking these agents included supportive care (due to the drugs’ short half-lives) or prothrombin complex concentrates (PCC), which are not FDA-approved for the reversal of factor Xa inhibitors. The use of oral factor Xa inhibitors, including rivaroxaban and apixaban, has increased over the last several years.

By: Danielle Marut, PharmD (left), Jessica Traeger, PharmD, BCCCP (right)

Andexxa prescribing information