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The anticoagulant activity of oral direct factor Xa (FXa) inhibitors and low-molecular-weight heparins such as enoxaparin can be reversed by andexanet, a modified, recombinant inactive form of FXa. Andexanet was recently approved by the FDA for this indication in patients on apixaban or rivaroxaban experiencing major bleeding.
To examine the efficacy and safety of andexanet, investigators conducted an industry-sponsored, multicenter, prospective, open-label cohort study in 352 patients with major bleeding while taking an FXa inhibitor. For patients exposed to apixaban, or to rivaroxaban more than 7 hours previously, the bolus dose of andexanet was 400 mg, followed by a 2-hour continuous infusion of 480 mg; for patients exposed to enoxaparin …