Andexanet alfa: A Novel Factor Xa Inhibitor Reversal Agent.

The purpose of this article is to review the available clinical trial data for andexanet alfa and its role in clinical practice. A MEDLINE/PubMed search was conducted (January 2000 to January 2019) using the keyword for clinical trials. References of identified articles were searched by hand for additional citations. We included English-language articles related to the Food and Drug Administration (FDA) approval of andexanet alfa or provided novel information regarding this drug entity. The findings of the review show that andexanet alfa may be a safe and effective option for the reversal of apixaban and rivaroxaban. With the approval of this reversal agent, patients and providers can feel safer when using apixaban and rivaroxaban, which in turn may increase the use of these anticoagulant agents. The new FDA approval of andexanet alfa will allow safer use of oral anticoagulants and will likely further the use of direct oral anticoagulants for anticoagulant needs. Reversing enoxaparin-/edoxaban-induced bleeding with this agent should be limited because there is no FDA approval owing to the fact that only phase II trial data available.