Abstract 15557: A Retrospective Study of Clinical Pathways and Outcomes of Andexanet Alfa Administration for Reversal of Critical Bleeding or Urgent Surgery in Patients on Oral Direct Factor Xa Inhibitors

Abstract

Introduction: Andexanet is FDA approved for reversal of life-threatening bleeding from factor Xa (FXa) inhibitors rivaroxaban and apixaban and off-label for urgent surgical reversal. Data are lacking on processes to ensure prompt andexanet dosing. Hypothesis: Presentation-to-andexanet time depends on clinical, demographic, and hospital factors. Goals: To identify factors impacting presentation-to-andexanet time and post-andexanet adverse outcomes. Methods: We retrospectively studied patients at a 23-hospital system who received andexanet from November 3, 2019, to March 4, 2023. Abstractors manually coded demographics, comorbidities, anticoagulant use, andexanet indication, and clinical pathway time stamps. The primary outcome was presentation-to-andexanet time. Secondary outcomes were post-andexanet major thromboembolism or bleeding, and in-hospital mortality. Results: 110 patients were analyzed (mean age 77.4 years, 71.3% White). Most patients were on lower dose FXa inhibitors without antiplatelets; 77% had at least 2 vascular comorbidities. Andexanet was used most for intracranial hemorrhage (ICH) (80%); 7% of doses were for urgent surgery (Table 1). Median presentation-to-andexanet time was 219 minutes. Linear regression showed non-ICH bleeding was associated with greater time to andexanet dose. More post-treatment thromboembolism or bleeding occurred at tertiary academic hospitals (p = 0.02). In-hospital mortality did not differ among hospital types (Table 2). Conclusions: In a retrospective study, a non-ICH site was associated with greater median time to andexanet dose. More post-andexanet adverse events occurred at tertiary hospitals.