ANNEXA-1: Andexanet Alfa Associated with Harm in DOAC Reversal
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Challenging Hemostatic Efficacy in DOAC Reversal
This chapter explores the use of Andexanet Alpha for reversing Direct Oral Anticoagulants in patients with intracerebral hemorrhage. It critically assesses hemostatic efficacy versus patient-centered outcomes, highlighting possible shortcomings in current evaluation criteria.
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Background: In May of 2018, Andexanet alfa gained accelerated approval by the FDA for the reversal direct oral anticoagulants (DOACs) despite a lack of robust evidence for use. The 2022 AHA/ASA guidelines give the drug a level 2A recommendation and recommend it over the use of 4F-PCC (Greenberg 2022). FDA approval alongside guideline endorsement has ... 
