Reversing factor Xa inhibitors - clinical utility of andexanet alfa
Recommended Citation
Kaatz S, Bhansali H, Gibbs J, Lavender R, Mahan CE, and Paje DG. Reversing factor Xa inhibitors - clinical utility of andexanet alfa. J Blood Med 2017; 8:141-149.
Document Type
Article
Publication Date
1-1-2017
Publication Title
J Blood Med
Abstract
Approximately half of patients started on an oral anticoagulant in the USA now receive one of the newer direct oral anticoagulants (DOACs). Although there is an approved reversal agent for the direct thrombin inhibitor dabigatran, a specific reversal agent for the anti-factor Xa (FXa) DOACs has yet to be licensed. Unlike the strategy to reverse the only oral direct thrombin inhibitor with idarucizumab, which is a humanized monoclonal antibody fragment, a different approach is necessary to design a single agent that can reverse multiple anti-FXa medications. Andexanet alfa is a FXa decoy designed to reverse all anticoagulants that act through this part of the coagulation cascade including anti-FXa DOACs, such as apixaban, edoxaban and rivaroxaban, and indirect FXa inhibitors such as low-molecular-weight heparins. This narrative reviews the development of andexanet alfa and explores its basic science, pharmacokinetics/pharmacodynamics, animal models, and human studies.
PubMed ID
28979172
Volume
8
First Page
141
Last Page
149
Comments
First published by Dove Medical Press, original version available at: https://doi.org/10.1097/CRD.0000000000000230. Creative Commons Attribution Non-Commercial License