AndexXa (coagulation factor Xa (recombinant), inactivated -zhzo) / Daiichi Sankyo, AstraZeneca - LARVOL DELTA

Treatment of Antithrombotic-Associated Intracranial Hemorrhage in Adults: A Focused Guideline Update from the Neurocritical Care Society and the Society of Critical Care Medicine. (PubMed, Neurocrit Care) - "The guideline writing panel provided new conditional recommendations for the treatment of antithrombotic-associated acute ICH. These recommendations are intended for consideration along with the patient's clinical status and patient-specific factors."

Journal • Cerebral Hemorrhage • CNS Disorders • Critical care • Hematological Disorders • Subarachnoid Hemorrhage • Vascular Neurology

Anticoagulants, Their Laboratory Monitoring, and Reversal. (PubMed, Hematol Rep) - "This review provides an overview of the major classes of anticoagulants, including unfractionated heparin (UFH), low molecular weight heparin (LMWH), fondaparinux, direct thrombin inhibitors, VKAs, and DOACs, with emphasis on their mechanisms of action, clinical applications, laboratory monitoring, and reversal strategies...The development of targeted reversal agents, including protamine, vitamin K, prothrombin complex concentrates, idarucizumab, and andexanet alfa, has significantly enhanced the safety of anticoagulant therapy in the setting of major bleeding or urgent procedures...Emerging anticoagulants targeting factors XI, XII, and XIII represent a promising future direction with the potential to further reduce bleeding risk while maintaining efficacy. Overall, continued advances in anticoagulant pharmacology, monitoring, and reversal strategies are driving a shift toward safer and more individualized patient care."

Journal • Review • Cardiovascular • Hematological Disorders • Thrombocytopenia

Thrombotic and ischemic event reporting with anticoagulant reversal agents: a multi-agent FAERS pharmacovigilance study. (PubMed, J Thromb Thrombolysis) - "We evaluated thrombotic and ischemic adverse-event reporting for andexanet alfa, idarucizumab, and a prothrombin complex concentrate (PCC) exposure set in the FDA Adverse Event Reporting System (FAERS). FAERS reports showed disproportionate thrombotic and ischemic reporting for all three reversal-agent exposure sets, with a prominent andexanet signal for ischemic stroke. These findings are hypothesis-generating and should not be interpreted as incidence, causality, or a direct comparative clinical-risk estimate."

Adverse events • Journal • Cardiovascular • Hematological Disorders • Ischemic stroke • Thrombosis

Reversal Is Not Hemostasis: What a Trauma Model Teaches Us about Andexanet Alfa and Four-Factor Prothrombin Complex Concentrate in Cardiac Surgery. (PubMed, J Cardiothorac Vasc Anesth) - No abstract available

Journal • Cardiovascular

Non-contrast CT Markers of Hematoma Expansion and Andexanet Response in Factor Xa Inhibitor-Associated Intracerebral Hemorrhage: An Analysis from ANNEXa-I Trial. (PubMed, Ann Neurol) - "These findings support the utility of NCCT markers for identifying patients at high risk of HE in FXai-associated ICH. ANN NEUROL 2026."

Journal • Cerebral Hemorrhage • Hematological Disorders

Management of pericardial effusion with andexanet alfa during epicardial ventricular tachycardia ablation. (PubMed, J Cardiol Cases) - "Specific consideration of anticoagulation strategies is required in patients with hemorrhagic complications during ablation procedure. This case presents the first reported use of andexanet alfa during catheter ablation for ventricular arrhythmias and emphasizes the importance of tailoring procedural strategies to each case, including consideration of the arrhythmogenic substrate location, to avoid thromboembolic complications."

Journal • Cardiovascular • Hematological Disorders • Ventricular Tachycardia

CytoSorb Application for Successful Control of Life-Threatening Gastrointestinal Bleeding Following Rivaroxaban Administration. (PubMed, Am J Case Rep) - "They are preferred over warfarin due to their rapid action and because they do not require routine blood monitoring...Our center did not have the specific reversal agent (andexanet alfa) for rivaroxaban on site due to its high cost, and the patient's condition was deteriorating rapidly, with evidence of ongoing bleeding...CONCLUSIONS This case study illustrates the potential of extracorporeal hemoperfusion as an adjunctive or alternative treatment for patients experiencing life-threatening bleeding associated with direct oral anticoagulants, particularly when reversal agents are unavailable. It provides rapid action and reduces the need for blood transfusions, potentially leading to a significantly shorter hospital stay for patients."

Journal • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology

Anticoagulation Stewardship in the Era of Practice-Changing Evidence: A Narrative Review of Recent Trials and Their Bedside Translation. (PubMed, J Clin Med) - " Seven developments warrant attention: (1) the 2023 AF guideline's ≥2%/year anticoagulation threshold, with sex-specific application and a 1-2%/year shared decision zone; (2) API-CAT-reduced-dose apixaban non-inferior to full dose for extended cancer VTE prevention (2.1% vs. 2.8%; adjusted subhazard ratio 0.76, 95% CI 0.41-1.41; pre-specified non-inferiority margin 2.00), with less bleeding (12.1% vs. 15.6%); (3) COBRRA-apixaban substantially safer than rivaroxaban in acute non-cancer VTE (clinically relevant bleeding 3.3% vs. 7.1%; RR 0.46, 95% CI 0.33-0.65; major bleeding 0.4% vs. 2.4%; RR 0.16, 95% CI 0.06-0.40), without efficacy trade-off; (4) ANNEXA-I-a modest hemostatic advantage for andexanet alfa over usual care (67.0% vs. 53.1%) at the cost of increased thrombosis (10.3% vs. 5.6%); (5) an asymmetric factor XI landscape in which class-level conclusions remain premature; (6) new special population data (ELDERCARE-AF, AZALEA sub-analyses by kidney function);..."

Journal • Review • Atrial Fibrillation • Cardiovascular • Hematological Disorders • Oncology • Venous Thromboembolism

PN217. The Clot Thickens: Navigating Fibrinogen Concentrates, PCCs, and DOAC Reversals in Cardiac Surgery (1 CME) (ASA 2026) - "DOAC associated coagulopathy will be discussed, in particular options for reversal and specific considerations in cardiac surgery, including complications associated with andexanet alfa and cardiopulmonary bypass...SessionLearningObjective2: At the conclusion of the session, the participant will be able to discuss the evidence surrounding utilization of prothrombin complex concentrates in lieu of plasma in cardiac surgery and in the setting of refractory coagulopathy. SessionLearningObjective3: At the conclusion of the session, the participant will be able to discuss options for reversal of DOAC associated coagulopathy, including direct reversal agents and factor concentrates."

Surgery • Cardiovascular • Hematological Disorders

From Andexanet to PCCs: Contemporary Approaches to DOAC Reversal in Cardiac Surgery (ASA 2026) - "There is no abstract associated with this presentation."

Surgery • Cardiovascular

From Thin to Thick and Back Again: A DOAC Odyssey Through Aortic Dissection (ASA 2026) - "A 73-year-old male on rivaroxaban presented with acute Type A aortic dissection complicated by hemopericardium with right ventricular compression after an unwitnessed fall. Postoperatively, he required re-exploration for hemothorax and subsequently developed bilateral pulmonary emboli necessitating reintubation and tracheostomy. This case highlights the thrombohemorrhagic balance of DOAC reversal in emergent aortic surgery following the 2025 U.S. withdrawal of andexanet alfa."

Cardiovascular • Hematological Disorders • Pulmonary Embolism

Case Report: Isolated homonymous hemianopia after reversal of anticoagulation with andexanet alfa. (PubMed, Front Neurol) - "Anticoagulation, however, increases the risk of haemorrhage and may require the use of a reversal agent (e.g., Andexanet alfa) in cases of severe bleeding. Unfortunately, reversal of anticoagulation in this setting can lead to an ischemic stroke and visual loss."

Journal • Atrial Fibrillation • Cardiovascular • Ischemic stroke

Andexanet Alfa vs Prothrombin Complex Concentrates in Patients with Factor Xa Inhibitor-associated GI Bleeding. (PubMed, Ann Am Thorac Soc) - No abstract available

Journal • Gastroenterology

Not all that glitters is gold. Is this the end of andexanet, the antidote to rivaroxaban and apixaban? (PubMed, Medicina (B Aires)) - No abstract available

Journal

Brazilian consensus on the management of bleeding complications related to the use of oral anticoagulants. (PubMed, Rev Assoc Med Bras (1992)) - "Management of bleeding in patients receiving oral anticoagulants requires rapid clinical assessment, severity stratification, targeted reversal strategies, and multidisciplinary care. Individualized reassessment of thrombotic versus hemorrhagic risk is essential to optimize outcomes and guide safe reintroduction of anticoagulation therapy after bleeding resolution."

Clinical guideline • Journal • Cardiovascular • Hematological Disorders • Thrombosis

Nanotechnology - Driven Innovations in Anticoagulant Delivery and Antidote Development for Hemostasis Regulation. (PubMed, Cardiovasc Hematol Disord Drug Targets) - "This review highlights the novelty of integrating nanotechnology-based delivery systems with targeted antidote strategies. Such convergence offers a patient-centred, safer, and more effective framework for anticoagulant therapy, while underscoring the need for future research in clinical translation, cost-effectiveness, and long-term safety."

Journal • Cardiovascular • Venous Thromboembolism

To reverse or not to reverse: Direct oral anticoagulants in mild traumatic brain injury. (PubMed, J Trauma Acute Care Surg) - "In isolated mild TBI after ground-level falls, DOAC usage was not associated with worsened clinical outcomes or increased radiographic progression. Pharmacologic reversal offered no measurable benefit. These findings support selective reversal in stable mild TBI. (J Trauma Acute Care Surg.)."

Journal • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Critical care • Hematological Disorders • Vascular Neurology

Urgent reversal of factor Xa inhibitors in emergent neurosurgery: A retrospective comparative study of 4F-PCC and andexanet alfa. (PubMed, Clin Neurol Neurosurg) - "This retrospective study provides real world data on the outcomes of urgent neurosurgical interventions following FXa-I reversal using 4F-PCC or AA. The optimal reversal strategy remains unknown. Short of a randomized trial, a prospective national registry of urgent perioperative FXa-I management could provide valuable insights into the efficacy of current and future DOAC reversal agents."

Journal • Retrospective data • Cerebral Hemorrhage • CNS Disorders • Critical care • Hematological Disorders

From empirical hemostasis to precision reversal: clinical challenges, technological innovations, and individualized strategies in anticoagulant-associated bleeding. (PubMed, Front Cardiovasc Med) - "While specific reversal agents (e.g., idarucizumab, andexanet alfa) have inaugurated an era of targeted precision reversal through high-affinity molecular neutralization, their widespread application is frequently hampered by exorbitant pharmacoeconomic costs, limited accessibility, and latent prothrombotic "off-target" effects (e.g., TFPI inhibition)...To circumvent existing limitations, current technological trajectories are pivoting towards the rational design of broad-spectrum synthetic molecules (e.g., ciraparantag) and highly programmable nucleic acid aptamer systems...We propose a multidimensional framework driven by point-of-care (POC) viscoelastic testing, algorithmic clinical decision support systems, and sequential therapy pathways managed by multidisciplinary "Code Bleed" teams. Future research must urgently prioritize large-scale, head-to-head randomized trials focused on patient-centered hard endpoints, ultimately refining evidence-based..."

Journal • Review • Cardiovascular • Hematological Disorders

A Study to Investigate Andexanet Dosing and the Interaction Between Andexanet and Subsequent Enoxaparin in Healthy Participants (clinicaltrials.gov) - P1 | N=191 | Completed | Sponsor: AstraZeneca | Active, not recruiting ➔ Completed

Trial completion

Major Bleeding During Factor Xa Inhibitor Therapy: Lessons from the Pre-Andexanet Era in Japan. (PubMed, J Atheroscler Thromb) - No abstract available

Journal

Choosing between the devil and the deep sea- Anticoagulation in malignancy after an intracranial bleed (ISTH 2026) - "Subsequently, the filter was removed and she resumed anticoagulation, with Apixaban...Aims We discuss the areas of uncertainity for anticoagulation: - time sensitive surgery with proximal thrombosis; balancing anticoagulation and the timing of of the surgery - controversy in inserting an inferior vena cava filter and its removal in the immediate postoperative period - role of andexanet alfa in reversal of anticoagulant effect of direct oral anticoagulants - restarting and choice of anticoagulation after a major bleed...Conclusions Choosing between the devil and deep sea aptly reflects the challenges faced by the clinician in a series of steps, where a razor thin margin divides equally challenging options affecting survival and morbidity. DOI*10.1016/j.rpth.2026.106598"

Cervical Cancer • CNS Disorders • Oncology • Solid Tumor • Thrombosis

Flat dosing hemostatic agents for emergent antithrombotic reversal in intracranial hemorrhages. (ISTH 2026) - "Science supports safety of a flat dosing for vitamin K, 4-factor prothrombin complex concentrate (4F-PCC), andexanet alpha (AA), Platelets, protamine, desmopressin (DDAVP), tranexamic acid (TXA) and cryoprecipitate. Rapid rounded-up supra-average dosing of HA allows cognitive offloading of the need for an infusion, also allowing for greater focus on other crucial interventions like blood pressure, glycemic and temperature rapid control and contemplation of neurosurgical interventions. DOI*10.1016/j.rpth.2026.105643"

Cerebral Hemorrhage • CNS Disorders • Hematological Disorders

Andexanet as a primer in a bundle for emergent neurosurgical interventions in intracranial bleeds (ISTH 2026) - "We propose a workflow based on reported US experiences and set the stage for a RCT or international registry to prove its value. DOI*10.1016/j.rpth.2026.105642"

Cerebral Hemorrhage • CNS Disorders • Hematological Disorders

Comparative effectiveness and safety of andexanet alfa versus four-factor prothrombin complex concentrate in factor Xa inhibitor–associated gastrointestinal bleeding: a systematic review and meta-analysis (ISTH 2026) - "Page 2 Table or Figure Upload (2) Forest plot of thrombotic events comparing andexanet alfa and four-factor prothrombin complex concentrate in factor Xa inhibitor–associated gastrointestinal bleeding. DOI*10.1016/j.rpth.2026.105635"

HEOR • Retrospective data • Review • Cardiovascular • Gastroenterology