Clot Chronicles: Andexanet

Dr. Sam Goldhaber discusses the newest development in anticoagulant medications, a new reversal agent called andexanet.

Hello, this is Dr. Sam Goldhaber. I am President of NATF and today on the Clot Chronicles we’re going to share some late breaking news. That is that the FDA approved a new medication called andexanet.

Andexanet is an antidote for major bleeding that can occur when patients are given direct oral anticoagulants, such as rivaroxaban, apixaban, edoxaban, or betrixaban. You may be more familiar with the trade names of some of these medications, which include Xarelto, Eliquis, and Savaysa.

Until now, we have not had a way to directly reverse this new class of oral anticoagulants. We are using these new oral anticoagulants more and more frequently, because they have fewer bleeding complications than warfarin. They are also much easier to administer because they are given in a fixed dose. There’s no need for any laboratory blood testing or dose adjustment. Not only are they safer, but, certainly for stroke prevention and atrial fibrillation, some of these direct oral anticoagulants, called DOACS and sometimes described as novel oral anticoagulants (NOACs), sometimes they’re even more effective for preventing stroke in patients who have atrial fibrillation.

The new antidote, just FDA approved, is a universal-type of agent that can reverse major bleeding from any of these DOACs that work against clotting factor Xa. So, andexanet is the antidote for four of the DOACs: rivaroxaban, apixaban, edoxaban, and betrixaban. It is delivered intravenously and it is an antidote that I am sure will be kept in all hospitals, in case they have to treat patients with major bleeding complications. It is an important addition to our armamentarium. For several years now, we have had an antidote for dabigatran, which is also called Pradaxa, and that antidote has worked very well, but it is only useful for patients who are taking dabigatran and not for the other direct oral anticoagulants. So now, when the other direct oral anticoagulants are prescribed, we can prescribe them with more confidence, knowing that in the rare situations where a major bleeding complication might occur, we can reach for andexanet as the reversal agent. This is Dr. Sam Goldhaber, signing off for the Clot Chronicles.

Andexanet has been FDA approved for the reversal of rivaroxaban and apixaban. For more information, click here.