The following is a summary of “Real world utilization of Andexanet alfa in the management of oral factor Xa inhibitor-associated gastrointestinal bleeding,” published in the November 2023 issue of Emergency Medicine by Brown, et al.

Andexanet alfa (AA) is approved for reversing factor Xa inhibitor (FXaI) bleeds, yet real-world data on its utilization for gastrointestinal bleeding (GIB) are limited. For a study, researchers sought to report real-world usage and assess the effectiveness of AA for FXaI-associated GIB.

Conducted from July 2018 to February 2021, this retrospective cohort study included consecutive patients receiving AA for FXaI-associated GIB. Data on demographics, blood product administration, hemostatic efficacy, rebleeding, thrombosis, and mortality rates were collected. Hemostatic efficacy categories included excellent (<10% decrease), good (≤ 20% decrease), or poor (>20% decrease, > 2 units of additional coagulation intervention, or death before repeat hemoglobin). Comparative transfusion requirements between efficacy groups were assessed.

The study included 22 patients, with 64% being male and a median age of 76 years (67, 80). Apixaban was the primary anticoagulant in 59% of cases, and atrial fibrillation was the main indication in 64% (n = 14). The median initial hemoglobin was 7.5 g/dL (IQR 6.4, 8.8), and 50% (n = 11) of cases involved upper gastrointestinal bleeding (GIB). Hemostatic efficacy was excellent in 46% (n = 10), good in 23% (n = 5), and poor in 32% (n = 7). No statistically significant difference in red blood cells (RBCs) received was observed between those with excellent/good hemostasis (median 2, IQR 1 to 2) and those with poor hemostasis (median 4, IQR 1.5 to 4.5). Two patients (9%) experienced arterial thrombotic events within 30 days of reversal.

Most achieved good hemostasis following AA administration in the real-world analysis of patients with FXaI-associated GIB. A 9% thrombotic event rate within 30 days was observed, emphasizing the need for careful consideration and further investigation. The study’s limitations included the lack of a control group, impacting the conclusions’ strength.

Source: sciencedirect.com/science/article/abs/pii/S0735675723004011