The group chose a fixed concentration of 1 mcg/mL for the FXa inhibitors, at which dose they all produced some anticoagulant effect, finding that edoxaban had the largest anticoagulant effect, followed by betrixaban, rivaroxaban, and apixaban. The researchers argue, based on their findings, that thromboelastography is a reliable approach to comparing the anticoagulant effects of these agents and their neutralization. The 2 concentrations were based on recommended dosing regimens. Taking a whole thromboelastographic approach to their analysis, the researchers found that the anticoagulant effects of the anti-Xa agents were partially neutralized at an AA dose of 50 mcg/mL and were completely neutralized at 100 mcg/mL. More recent data show that AA may also have the same effect for edoxaban and betrixaban, the latter approved but currently off the market. In 2018, the FDA granted accelerated approval to AA as an antidote for the reversal of apixaban and rivaroxaban anticoagulation. Similar to other anticoagulants, FXa inhibitors approved in this setting-apixaban, edoxaban, and rivaroxaban-come with risks of uncontrolled and life-threatening bleeding. ![]() Andexanet alfa (AA), a molecularly modified recombinant coagulation factor Xa (FXa), is able to fully neutralize the anticoagulant effects of factor Xa inhibitors used for thrombotic disorders, suggest study findings published in Clinical and Applied Thrombosis/Hemostasis, which showed a concentration-dependent effect of the antidote.
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