Andexanet alfa (Andexxa)

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General information

Class/mechanism: Recombinant inactive FXa, used for specific reversal of DOACs (direct oral anticoagulants) Rivaroxaban (Xarelto) and Apixaban (Eliquis). Coagulation factor Xa (recombinant) inactivated-zheo binds and sequesters rivaroxaban and apixaban, negating their factor Xa inhibiting, anticoagulant effect. It also inhibits Tissue Factor Pathway Inhibitor (TFPI); inhibition of TFPI can increase tissue factor-initiated thrombin generation.[1][2][3]
Route: IV
Extravasation: no information

For conciseness and simplicity, currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.[1]

Patient drug information

Diseases for which it is used

History of changes in FDA indication

  • 2018-05-04: Approved for patients treated with rivaroxaban and apixaban, when reversal of anticoagulation is necessary due to fatal or uncontrolled bleeding.

History of changes in PMDA indication

  • 2022-03-28: Newly indicated for the reversal of anticoagulant effect in life-threatening or uncontrolled bleeding in patients treated with a direct-acting factor Xa inhibitor (apixaban, rivaroxaban, or edoxaban tosilate hydrate).

Also known as

  • Code name: PRT-4445
  • Generic name: coagulation factor Xa recombinant inactivated-zhzo
  • Brand name: Andexxa, Ondexxya