In this episode, I’ll discuss how andexanet alpha can be used to reverse heparin.
Andexanet alpha has been approved for reversal of anticoagulation from rivaroxaban and apixaban. But there is also reason to believe that andexanet alpha can be used as a reversal agent for heparin. In a 2015 in vitro study in the journal Blood, andexanet alpha dose-dependently reversed the anti-Xa activity of heparin in the enzymatic assay and in human plasma. Interestingly, andexanet alpha was also able to reverse the heparin anti-IIa activity in the same assay to baseline levels. This in vitro study suggests that andexanet alpha could be a universal Xa inhibitor antidote to reverse a broad range of newer direct oral Xa inhibitors, ATIII-dependent indirect inhibitors, such as fondaparinux and enoxaparin, as well as unfractionated heparin.
Members of my Hospital Pharmacy Academy can access my training video on the reversal of heparin, complete with 5 different case studies using the currently approved therapy of protamine. To get immediate access go to pharmacyjoe.com/academy.
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