Andexanet alfa works as a decoy drug for Factor Xa inhibitors in the blood, and prevents drug inhibition of native Factor Xa.
INDICATIONS: apixaban / rivaroxaban exposure w/in 24h of life-threatening bleed:
- acute intracranial hemorrhage (approval from stroke neurologist / neurointensivist / neurosurgeon)
- spinal or epidural hemorrhage (approval from site medical director)
- intraocular hemorrhage with vision compromise (approval from site medical director)
- airway or pulmonary hemorrhage (approval from site medical director)
- hemopericardium (approval from site medical director)
- aortic rupture, dissection or hemorrhage (approval from site medical director)
- closed space hemorrhage – compartment syndrome risk (approval from site medical director)
*Not indicated for bleeding from all other sites.
(1 vial = 200mg = 20 mL)
- thrombotic events
- incomplete reversal
- Anti-FXa levels return to placebo levels ~12h after complution of bolus or infusion.
- interferes with indirect anti-Xa inhibitors (UFH)
- infusion related-reactions in 18% of healthy volunteers
Note: DO NOT co-administer andexanet and Kcentra.
Note: Andexanet has not been studied in patients requiring reversal prior to urgent or emergent surgery – concern for rebound bleeding / hypercoagulability, unpredictable pharmacokinetics, lack of data in surgical population. PCCs have been studied in the surgical population.
- fever, rigors, severe chills
- oxygen desaturation
- agitation / confusion
- flushing, feeling hot