andexanet alfa

Andexanet alfa is a recombinant analogue of factor Xa designed as a decoy for the oral factor Xa inhibitors. It has the active site serine residue replaced with an alanine residue to eliminate catalytic activity and the Gla domain removed to preclude its incorporation in the prothrombinase complex. By sequestering circulating factor Xa inhibitors, andexanet rapidly reverses the anti–factor Xa activity produced by these agents and restores thrombin generation.

Adult

intravenous bolus followed by a 2-h infusion. Higher doses are needed to reverse rivaroxaban or edoxaban than apixaban.

• use in patients undergoing procedures where heparin is used routinely, such as vascular or cardiac surgery (because it also reverses the anticoagulant effect of heparin and LMWH)