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Risk Factors Associated with Thrombus Development Following Pharmacologic Anticoagulation Reversal with Coagulation
David Zingale1, Raymond Lamore2, Derek Peiffer2
1University of Utah Health, Salt Lake City, UT, USA.
Hospital Pharmacy
|October 20, 2025
Summary
Major surgery within 30 days of Andexanet alfa (AA) administration is a significant risk factor for developing thrombus. This finding is crucial for managing patients receiving AA for bleeding complications.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Hematology
Background:
- Andexanet alfa (AA) is an antidote for bleeding associated with rivaroxaban and apixaban.
- Thromboembolism is a known risk with AA, with higher rates observed compared to usual care.
Purpose of the Study:
- To identify patient-specific and hospital-associated risk factors for thrombus development after AA administration.
- To analyze predictors of thrombotic events in patients receiving AA.
Main Methods:
- Retrospective cohort study across six academic and community institutions.
- Inclusion of 138 adult inpatients who received AA between November 2021 and June 2024.
- Evaluation of risk factors for thrombus development within 45 days of AA administration.
Main Results:
- Thirteen-point-eight percent (19/138) of patients developed thrombus after AA.
- Major surgery within 30 days of AA administration was a strong predictor of thrombus development (OR 3.72, P=.03).
Conclusions:
- A significant association exists between recent major surgery and thrombotic complications post-AA.
- Further research is needed to validate these findings and improve risk stratification for patients receiving AA.
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