• Br J Anaesth · Feb 2024

    Editorial

    Andexanet alfa or prothrombin complex concentrate for acute reversal of oral factor Xa inhibitors: monitoring of antidote effects.

    • Kenichi A Tanaka and Jerrold H Levy.
    • Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: kenichi-tanaka@ouhsc.edu.
    • Br J Anaesth. 2024 Feb 1; 132 (2): 215217215-217.

    AbstractThis study in vitro comprehensively assessed reversal of the anticoagulant effects of rivaroxaban, an oral factor Xa inhibitor, using andexanet alfa and various prothrombin complex concentrate (PCC) products in a battery of tests. In static coagulation assays, andexanet alpha outperformed PCCs except for activated PCC being more effective in standard coagulation times. However, in a flow chamber model mimicking arterial shear, both andexanet alpha and high-concentration PCC restored fibrin formation, but not platelet adhesion. In the Russell's viper venom test and anti-Xa assay, only andexanet alpha could be tested for efficacy. The antidote effects of andexanet alpha and PCCs in restoring coagulation can be qualitatively or selectively demonstrated using in vitro coagulation tests.Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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