The ANNEXA-A and ANNEXA-R trials showed that andexanet alfa quickly reversed the anticoagulant effects of rivaroxaban and apixaban in healthy patients and the ANNEXA-4 trial provided safety and efficacy data for patients on factor Xa inhibitors who were actively bleeding and required reversal. Andexanet alfa is now available nationwide. It’s also not approved to reverse anticoagulation prior to procedures. It’s currently not approved to reverse the effects of the other factor Xa inhibitors, betrixaban and edoxaban, or the indirect Xa inhibitors, such as enoxaparin. It was approved by the FDA in May 2018 to reverse the effects of rivaroxaban and apixaban in the event of serious bleeding that cannot be controlled with supportive measures. Now, andexanet alfa (Andexxa ®) is available to reverse the factor Xa inhibitors (such as apixaban and rivaroxaban).Īndexanet alfa is an antidote that reverses the anticoagulant effects of the factor Xa inhibitors. A few years ago, the reversal agent, idarucizumab (Praxbind ®), became available to reverse the effects of dabigatran (Pradaxa ®, an oral direct thrombin inhibitor).

Until recently, there has not been a specific reversal agent for these agents in the event of significant bleeding or an unexpected urgent procedure.

These newer anticoagulants are at least as effective as warfarin and have a similar or decreased risk of bleeding – especially major bleeding.ĭespite the lower risk of major bleeding with these agents, some risk remains and may increase due to trauma or major surgery. For decades, warfarin was the only FDA-approved oral anticoagulant for stroke prevention in atrial fibrillation (Afib) and for the treatment and prevention of venous thromboembolism (VTE), but newer treatments have emerged in the form of direct oral anticoagulants (DOACs).

Andexxa alfa