Template:Factor Xa Inhibitor Reversal: Difference between revisions
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===[[Andexanet alfa]]=== | ===[[Andexanet alfa]]=== | ||
FDA approved in May 2018, limited availability June 2018 | FDA approved in May 2018, limited availability June 2018 | ||
*Cost is $20,000 to $55,000 per dose | |||
*Trial that led to FDA approval does not have the most sound evidence behind it <ref>Connolly SJ, Crowther M, Eikelboom JW, et al. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2019</ref>: | |||
**Prospective single center single group study of 352 patients receiving a Factor Xa Inhibitor ([[apixaban]], [[rivaroxaban]], [[edoxaban]], [[enoxaparin]]) with life threatening bleed (those with expected survival <1 month were excluded). | |||
**Anti-Factor Xa activity was decreased in all groups. 82% were judged to have excellent hemostatic control. 14% mortality rate at 30 days. | |||
**No comparison group available. It is unlikely that following anti-Factor Xa activity as a lab value is clinically important. High mortality rate even after excluding sick patients. | |||
====Low Dose==== | ====Low Dose==== | ||
'''400''' mg IV bolus at rate of ~30 mg/minute, followed 2 minutes later by '''4''' mg/minute for up to 120 minutes | '''400''' mg IV bolus at rate of ~30 mg/minute, followed 2 minutes later by '''4''' mg/minute for up to 120 minutes | ||
====High Dose==== | ====High Dose==== | ||
'''800''' mg IV bolus at rate of ~30 mg/minute, followed 2 minutes later by '''8''' mg/minute for up to 120 minutes | '''800''' mg IV bolus at rate of ~30 mg/minute, followed 2 minutes later by '''8''' mg/minute for up to 120 minutes | ||
Latest revision as of 22:03, 11 February 2020
Factor Xa Inhibitor Reversal
| Anticoagulant | Half-life | Removed by HD | Strategies to reverse or minimize anticoagulant effects |
| Apixaban[1] (Eliquis®) | 8-15 hrs (longer in renal impairment) | No |
|
| Edoxaban[2] (Savaysa®) | 10-14 hrs (longer in renal impairment) | ~ 25% | As above |
| Rivaroxaban[3] (Xarelto®) | 9-13 hrs (longer in renal impairment) | No | As above |
| Fondaparinux (Arixtra®) | 17-21 hrs (significantly longer in renal impairment) | No | 4-factor PCC (Kcentra™)^ 50 units/kg—max 5000 units |
^Off-label
Andexanet alfa
FDA approved in May 2018, limited availability June 2018
- Cost is $20,000 to $55,000 per dose
- Trial that led to FDA approval does not have the most sound evidence behind it [4]:
- Prospective single center single group study of 352 patients receiving a Factor Xa Inhibitor (apixaban, rivaroxaban, edoxaban, enoxaparin) with life threatening bleed (those with expected survival <1 month were excluded).
- Anti-Factor Xa activity was decreased in all groups. 82% were judged to have excellent hemostatic control. 14% mortality rate at 30 days.
- No comparison group available. It is unlikely that following anti-Factor Xa activity as a lab value is clinically important. High mortality rate even after excluding sick patients.
Low Dose
400 mg IV bolus at rate of ~30 mg/minute, followed 2 minutes later by 4 mg/minute for up to 120 minutes
High Dose
800 mg IV bolus at rate of ~30 mg/minute, followed 2 minutes later by 8 mg/minute for up to 120 minutes
- ↑ Eliquis prescribing information. Princeton, NJ: Bristol Myers Squibb; December 2012.
- ↑ Savaysa prescribing information. Parsippany, NJ: Daiichi Sankyo, Inc.; November 2015.
- ↑ Xarelto prescribing information. Titusville, NJ: Janssen Pharmaceuticals, Inc.; December 2014.
- ↑ Connolly SJ, Crowther M, Eikelboom JW, et al. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2019