Interruption of anticoagulation may result in thromboembolic and ischemic events. Clinical studies show that andexanet alfa improves markers related to coagulation, and reverses major bleeding in healthy volunteers and patients with life-threatening bleeding. Studies evaluating laboratory parameters for coagulation show that andexanet alfa rapidly neutralizes the anticoagulant effects of apixaban, enoxaparin, edoxaban, and rivaroxaban. The use of andexanet alfa for reversing FXa inhibitor-associated anticoagulation were evaluated in the phase III ANNEXA-4 study. The safety and tolerability of andexanet alfa were evaluated in one phase I, two phase II, and one phase III clinical trials. Bibliographies of selected articles were reviewed manually for relevant publications, focusing on reversal strategies for apixaban, enoxaparin, edoxaban, or rivaroxaban associated anticoagulation using andexanet alfa. Portola Pharmaceuticals was contacted for information used for United States Food and Drug Administration approval of andexanet alfa.Įnglish-language clinical trials and reviews published between January 2008 and April 2019 were included for review. Additional online searches via PubMed, Google Scholar, and Lexicomp were conducted for both prescribing and cost information. In the present review, we identified articles via PubMed using the combined keywords andexanet alfa, apixaban, enoxaparin, edoxaban, and rivaroxaban. Review of clinical data on andexanet alfa for the reversal of factor Xa (FXa) inhibitor associated anticoagulation.

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