Internal medicine

Heparin

Atrial fibrillation

Antidote

Surgery

Warfarin

Coagulation

Rivaroxaban

Prothrombin complex concentrate

Antithrombin

Coagulopathy

Apixaban

Toxicity

Medicine

Pharmacology

Journal of Cardiothoracic and Vascular Anesthesia

ANDEXANET ALFA (Ondexxya, Portola Pharmaceuticals, San Francisco, CA) is a modified recombinant inactivated human factor Xa. Although it currently only is approved to reverse the effects of direct factor Xa (FXa) inhibitors, andexanet alfa initially was developed as a reversal agent for direct and indirect FXa inhibitors.1 The agent acts as a decoy FXa molecule that reversibly binds FXa inhibitors and consequently temporarily inhibits the anticoagulant effects. In vitro studies showed a binding affinity for heparin-bound antithrombin and suggested an inhibitory effect against heparin-induced coagulopathy.

Successful Antithrombin Administration in Andexanet Alfa-Associated Heparin Resistance