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Kaatz S, Bhansali H, Gibbs J, et al. Reversing factor Xa inhibitors - clinical utility of andexanet alfa. J Blood Med. 2017;8:141-149doi: 10.2147/JBM.S121550.
Kaatz, S., Bhansali, H., Gibbs, J., Lavender, R., Mahan, C. E., & Paje, D. G. (2017). Reversing factor Xa inhibitors - clinical utility of andexanet alfa. Journal of blood medicine, 8141-149. https://doi.org/10.2147/JBM.S121550
Kaatz, Scott, et al. "Reversing factor Xa inhibitors - clinical utility of andexanet alfa." Journal of blood medicine vol. 8 (2017): 141-149. doi: https://doi.org/10.2147/JBM.S121550
Kaatz S, Bhansali H, Gibbs J, Lavender R, Mahan CE, Paje DG. Reversing factor Xa inhibitors - clinical utility of andexanet alfa. J Blood Med. 2017 Sep 13;8:141-149. doi: 10.2147/JBM.S121550. eCollection 2017. PMID: 28979172; PMCID: PMC5602457.
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J Blood Med. 2017 Sep 13;8:141-149. doi: 10.2147/JBM.S121550. eCollection 2017.

Reversing factor Xa inhibitors - clinical utility of andexanet alfa.

Journal of blood medicine

Scott Kaatz, Hardik Bhansali, Joseph Gibbs, Robert Lavender, Charles E Mahan, David G Paje

Affiliations

  1. Division of Hospital Medicine.
  2. Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.
  3. Division of General Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
  4. University of New Mexico, Presbyterian Healthcare Services, Albuquerque, NM.
  5. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.

PMID: 28979172 PMCID: PMC5602457 DOI: 10.2147/JBM.S121550

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.

Keywords: DOAC; andexanet alfa; apixaban; factor Xa; reversal; rivaroxaban

Conflict of interest statement

Disclosure SK received a speaker’s honorarium from Janssen, Boehringer- Ingelheim, Bristol Myer Squibb, Pfizer, CSL Behring, and Daiichi Sankyo; is a consultant in Boehringer Ingelheim, Bristol Myer S

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