Four-factor prothrombin complex concentrate plus andexanet alfa for reversal of factor Xa inhibitor–associated bleeding: Case series

• Published in: American journal of health-system pharmacy 2022-08, Vol.79 (16), p.1323-1329
• Main Authors: Liu, JiTong, Elsamadisi, Pansy, Philips, Eli, Bauer, Kenneth A, Eche, Ifeoma M
• Format: Article
• Language: English
• ISSN: 1079-2082; 1535-2900
• DOI: 10.1093/ajhp/zxac079

Abstract Purpose To manage factor Xa (FXa) inhibitor–associated bleeding, andexanet alfa or 4-factor prothrombin concentrate (4F-PCC) has been used to restore hemostasis. However, literature on the outcomes for patients who received both andexanet alfa and 4F-PCC is limited. Summary We report a case series of 5 patients who received andexanet alfa plus 4F-PCC for reversal of FXa inhibitor–associated bleeding. Patients were included in this case series if they received both andexanet alfa and 4F-PCC for reversal of FXa inhibitor–associated bleeding. They were followed to either discharge or death, and in-hospital complications related to concurrent use of andexanet alfa and 4F-PCC were documented. We report an incidence of thromboembolism of 40% (2 of 5 cases) and an in-hospital mortality rate of 60% (3 of 5 cases). Taking these cases together with those in the existing literature, we found a total of 23 reported cases of safety outcomes with andexanet alfa plus 4F-PCC. The overall incidence of thromboembolism was 35% (8 of 23 cases). Conclusion This case series adds to the limited literature describing the outcomes for patients receiving andexanet alfa plus 4F-PCC. We encourage other institutions to report safety data on administering both agents.