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

In this article, the authors report a case series of 23 total patients, 5 patients from the author’s institution and 18 other cases found in the literature, who received andexanet alfa in addition to 4F-PCC (4-factor prothrombin complex concentrate) for the reversal of factor Xa inhibitor (apixaban, rivaroxaban). Prior to andexanet being marketed, factor Xa associated bleeding was managed with supportive care and 4-factor PCC or activated prothrombin complex concentrate. Current data does not show a preference for andexant or 4F-PCC (although some guidelines recommend andexanet) and patients who receive these reversal agents may be at risk for thrombosis. While the literature is lacking on thrombosis rates when using these agents in combination, the authors found an overall incidence of thromboembolism of 35% (8 of 23 patients). This rate is higher than those reported with individual agents. Clinicians should remain aware of the increased thromboembolism risk when choosing to administer 4F-PCC in combination with andexanet alfa.