Anticoagulation Reversal Updates and Review I’ll begin with the heavy hitting news first that Andexanet alfa (Andexxa) was approved by the FDA this month as a reversal agent for factor Xa inhibitors (specifically approved for apixaban and rivaroxaban).
Note this is not approved for other Xa inhibitors or indirect inhibitors (i.e. Lovenox).
The drug should be available Summer of 2018 in limited supply with broader commercial launch in early 2019.
This comes after the drug was declined approval in 2016
MOA: Recombinant modified human factor Xa molecule which servces as a decoy binding with Xa inhibitors in the patient’s blood.
For Life-Threatening Bleeding
Anticoagulant Reversal Agent Warfarin (Coumadin) K-centra (4 Factor PCC) + Vit K * Lovenox Protamine Sulfate (partial) Heparin Protamine Sulfate Direct Thrombin Inhibitors Dabigatran (Pradaxa) Dabigatran (Pradaxa) Argatroban, Bivalirudin, Lepirudin K-centra/Supportive Factor Xa Inhibitors Apixaban and Rivaroxaban Praxbind (idarucizumab) Edoxaban, Fondaparinux K-centra
*Note for non-life threatening bleeding refer to guides; may administer Vit K, etc.
UNC Healthcare
UpToDate
Aliem