Print Share Email Send Email Your Name (required) ! Example: John Doe Email Address (required) ! Error: Please enter a valid sender email address. Example: firstname.lastname@example.org CC Me Recipient Email Address (required) ! Separate multiple email address with semi-colons (up to 5). Subject Subject for your email. Message (Maximum characters: 1,000) Error: Please enter your name Error: Please enter your email address Error: Please enter a valid recipient email address. Example:email@example.com Thank you! Your email has been sent to: The recipient(s) will receive an email message that includes a link to the selected article. Recipients may need to check their spam filters or confirm that the address is safe. Return to: Send Another Email An error has occurred sending your email(s). Please try again later or contact an administrator at OnlineCustomer_Service@email.mheducation.com. Return to: Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Calenda B, Kadian-Dodov D. Calenda B, Kadian-Dodov D Calenda, Brandon, and Daniella Kadian-Dodov. "Andexanet alfa in Factor Xa Inhibitor-Associated Acute Major Bleeding." Hurst's the Heart Updates, 24 May 2016. McGraw-Hill, New York, NY, 2016. AccessCardiology. http://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=424345§ionid=189592021 MLA Citation Calenda B, Kadian-Dodov D. Calenda B, Kadian-Dodov D Calenda, Brandon, and Daniella Kadian-Dodov.. "Andexanet alfa in Factor Xa Inhibitor-Associated Acute Major Bleeding." Hurst's the Heart Updates Fuster V. Fuster V Fuster, Valentin. New York, NY: McGraw-Hill, 2016, http://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=424345§ionid=189592021. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Tools Clip Full Chapter Figures Only Tables Only Videos Only Supplementary Content Top Andexanet alfa in Factor Xa Inhibitor-Associated Acute Major Bleeding by Brandon Calenda, MD; Daniella Kadian-Dodov, MD, + +Update to Chapter 83: Atrial Fibrillation, Atrial Flutter, and Atrial Tachycardia and Chapter 97: Diagnosis and Management of Diseases of the Peripheral Venous System Study Summary + +Andexanet alfa is an inactive protein that binds and sequesters factor Xa inhibitors (FXaIs). Interim analysis of the ANNEXA-4 Phase 3b/4 single-arm, open label study evaluated efficacy and safety of Andexanet alfa in 132 patients with FXaI-associated life-threatening bleeding and clinical hemostasis at 12 hours post-IV bolus and infusion. Patients with FXaI exposure ≤ 18 hours and acute bleed causing hemodynamic instability, hemoglobin decrease > 2 g/dL, or evidence of critical organ damage (e.g. intracranial hemorrhage) were included. Recent thrombosis, recent administration of blood products, Glasgow coma scale score < 7, ICH volume > 60 cc, life expectancy < 1 month, or upcoming surgery were exclusion criteria. Patients presented primarily with intracerebral hemorrhage (61%) and gastrointestinal bleeding (27%). Andexanet alfa significantly lowered anti-FXa activity levels across subgroups and all FXaIs (see accompanying Hurst’s Central Illustration). “Excellent or good” hemostasis occurred in 83% (109/132). At 30 days, thrombotic events occurred in 24 patients; 27 patients died (11 cardiovascular deaths); 16 patients died after intracerebral hemorrhage. + Reversal Agents for Anticoagulants Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) Commentary + +Study Strengths: This is a “real world” assessment of the safety and efficacy of andexanet alfa as a universal FXaI antidote. Cases and outcomes were independently adjudicated with standardized criteria; an independent core lab reviewed brain imaging. +Study Limitations: The time from presentation to andexanet alfa was 5 ± 3.1 hours; reasons for delay to treatment are not clear. During follow-up, only 57% of patients resumed anticoagulation, which may account for thrombotic events. The follow-up period was relatively short (30 days). +Next Steps/Clinical Perspective: Andexanet alfa appears to be an effective option for universal FXaI reversal in the setting of acute, life-threatening bleeding. Drug approval, accessibility, availability, and cost-effectiveness remain to be seen.