Global Health AN ONLINE JOURNAL FOR THE DIGITAL AGE alfa also inhibits tissue factor pathway inhibitor, which leads to an increase in tissue factor-initiated thrombin generation.1 In terms of safety, andexanet alfa does have a Black Box Warning for serious and life- threatening effects such as arterial and venous thromboembolic events, ischemic events, cardiac arrest, and sudden deaths. Due to these Ralf Jadoopat risks, patients should be closely monitored and Pharm D. Candidate 2019 anticoagulation should be initiated only when The University of Findlay College of medically appropriate. The most common Pharmacy adverse event based on clinical trial data was Findlay, OH infusion-related reactions (frequency of 18%). USA 45840 These reactions included flushing, cough,
[email protected] dysgeusia, and dyspepsia. The symptoms were mild-to-moderate in severity and 90% of REVIEW OF ANDEXANET ALFA AND patients experiencing these effects did not IMPLICATIONS FOR GLOBAL HEALTH require treatment.1,2 There are two dosing regimens available for As direct oral anticoagulants (DOACs) are andexanet alfa. The regimen used is based on being more frequently prescribed, there is a specific factor Xa inhibitor given, the factor Xa pressing need for a reversal agent for these inhibitor dose, and time since it was last medications. Dabigatran was the first DOAC administered. The low dose regimen is a 400mg to have a specific reversal agent with the IV bolus administered at a rate of 30mg/min, approval of idarucizumab (Praxbind®). A new followed by a 4mg/min IV infusion for up to reversal agent called andexanet alfa 120min. The high dose regimen is an 800mg IV (Andexxa®), manufactured by Portola bolus administered at a rate of 30mg/min, Pharmaceuticals and was approved by FDA in followed by an 8mg/min IV infusion for up to May 2018 for patients treated with 120min.1,2 rivaroxaban or apixaban that are experiencing Each package of andexanet alfa contains four life-threatening or uncontrolled bleeding.