Andexanet Alfa
Reversal of rivaroxaban or apixaban for life-threatening bleeding
Indications
- Reversal of rivaroxaban or apixaban for life-threatening bleeding
Adult dosing
- low dose: dose: 400; unit: mg IV bolus then 480mg infusion over 2h; route: IV; fixed: true; high dose: dose: 800; unit: mg IV bolus then 960mg infusion over 2h; route: IV; fixed: true
Pediatric dosing
- contraindicated: true; reason: No pediatric data available; adult-only indication
Clinical pearls
- Low dose: apixaban at any dose, rivaroxaban ≤10mg or last dose >8h ago
- High dose: rivaroxaban >10mg and last dose <8h ago, or enoxaparin
- ANNEXA-4 trial showed 82% hemostatic efficacy
- Very expensive (~$25,000-50,000) — consider PCC as alternative
Source and review
- Connolly et al., NEJM 2019 (ANNEXA-4). Last reviewed: 2024-11-01