The Potential of Andexanet Alfa as a Reversal Agent for Direct Oral Anticoagulants

Abstract

Purpose: The purpose of this article is to describe the role of andexanet alfa as a reversal agent in the management of bleeding complications associated with direct oral anticoagulants (DOACs). Summary: Over the past several years, DOACs are increasingly being used in the management of patients with non-valvular atrial fibrillation or stroke prevention. Management of major bleeding in DOAC therapy includes supportive therapy and addressing any factors that are contributing to blood loss. Additionally, there may a need to expedite the removal of any anticoagulation effects by removing or neutralizing the anticoagulant. Until recently, there was no specific reversal agent for DOACs; management approaches were limited to util ©Wizing concentrated clotestern University oft Health Sciencesing factors or fresh frozen plasma. The FDA granted expedited approval of andexanet alfa as a specific reversal agent for the DOACs to meet this unmet need. Conclusion: In clinical trials, andexanet alfa demonstrated a significant reduction in anti-Xa activity in patients with a major bleeding event on apixaban or rivaroxaban. The clinical benefit of this anti-Xa activity reduction has yet to be demonstrated in a randomized controlled trial. The current lack of randomized controlled trials demonstrating clinical benefit and the high cost of the drug has limited the widespread use of this antidote.