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The new oral anti-Xa inhibitors apixaban, edoxaban, and rivaroxaban have advantages over vitamin K antagonists, but the absence of an anti-Xa reversal agent has limited their widespread adoption. Andexanet is a compound that binds tightly to the active site of these anti-Xa anticoagulants, preventing further inhibition of factor Xa.
To examine the safety and efficacy of andexanet, investigators conducted an industry-sponsored, double-blind, placebo-controlled, phase II trial in nonbleeding adults aged 50 to 75. Participants received either apixaban (5 mg) or rivaroxaban (20 mg) for 4 days followed by a 400 mg intravenous bolus of andexanet; some subjects then received a 2-hour continuous intravenous infusion of andexanet. The primary endpoin…