8, 9 Andexanet is a modified, recombinant, enzymatically inactive form of FXa, which binds and sequesters FXa inhibitors, thereby neutralizing their anti-FXa activity. 6, 7Īndexanet alfa (US adopted name: coagulation factor Xa inactivated-zhzo) is a specific reversal agent approved by the US Food and Drug Administration and the European Medicines Agency for uncontrolled or life-threatening bleeding related to the oral FXa inhibitors apixaban and rivaroxaban. 4, 5 Despite their superior safety, ≈0.3% to 0.5% of patients receiving FXa inhibitors suffer intracranial hemorrhage (ICrH) annually, 1–3 which is associated with 30-day mortality rates of 27% to 48%. Large clinical trials have demonstrated that FXa inhibitors are as effective and safer than warfarin 1–3 and are now widely recommended by guidelines.
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