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Background: Direct oral anticoagulants (DOACs) are a cornerstone of therapy in treatment and prevention of deep vein thrombosis, pulmonary embolism and other thromboembolic disorders. Despite their favorable safety profile, patients are still at an increased risk of intracranial hemorrhages (ICH), gastrointestinal (GI) and/or fatal bleeding. Two agents commonly used in DOAC associated bleeding include andexanet-alfa and four factor prothrombin concentrate complex (4F-PCC). Reversal agent selection is determined by clinical presentation, cost, and institutional preference. 4F-PCC costs $9,099 per patient compared to $12,310 and $22,158 for low dose and high dose of andexanet-alfa respectively. Objectives: To evaluate adherence to Henry Ford Health System (HFHS) 2023 “Tier 1: Anticoagulation Reversal Guidelines” and determine cost efficiency in the management of DOAC-associated bleeding with andexanet-alfa.

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Henry Ford Health


Detroit, Michigan


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Project #09: Potential Cost Savings in the Reversal of DOAC Associated Bleeding



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