The Bottom Line - Feb 5 2016
Siegal DM. N Engl J Med 2015 - doi: 10.1056/NEJMoa1510991
Clinical Question
- In healthy adults taking either apixaban (ANNEXA-A) or rivaroxaban (ANNEXA-R) does andexanet alfa compared to placebo normalise anticoagulation?
The Bottom Line
- Both ANNEXA-A and ANNEXA-R show impressive reversal of anti-factor Xa activity by andexanet.
- It should however be made clear that safety data of any meaning will only come from larger phase 3b-4 studies, which are in progress (Clinical trials.gov NCT02329327). Caution must be exercised with any new drug particularly if the results are used to guide emergency reversal of patients anti-coagulated with factor Xa inhibitors, which of course is the intended aim of such agents due to the myriad of factors that affect bleeding tendency in the acute setting.