Institutional Experience of Using Andexanet Alfa

Area of Science:

• Pharmacology
• Hematology
• Clinical Medicine

Background:

• Direct-acting oral anticoagulants (DOACs) are widely used for atrial fibrillation and venous thromboembolism.
• Andexanet alfa is an FDA-approved reversal agent for apixaban and rivaroxaban, used in life-threatening bleeding.
• Real-world data on andexanet alfa utilization is crucial for community hospital settings.

Purpose of the Study:

• To present a retrospective review of andexanet alfa utilization in a community hospital.
• To evaluate the efficacy and safety of andexanet alfa in patients with intracranial bleeding.

Main Methods:

• Single institutional retrospective review of patients receiving andexanet alfa.
• Analysis of hemostasis, mortality, and thromboembolic events in four patients over 10 months.

Main Results:

• Four patients received andexanet alfa for intracranial bleeding.
• Excellent hemostasis was achieved in 50% (2) of patients.
• 30-day mortality was 75% (3), and 25% (1) experienced a thromboembolic event.
• Anticoagulation was not restarted in any patient.

Conclusions:

• Andexanet alfa use in a community hospital setting for intracranial bleeding showed variable outcomes.
• High mortality and thromboembolic event rates warrant further investigation.
• Real-world utilization data highlights the need for careful patient selection and monitoring.