![]() ![]() 3 So how have we managed to this point without a reversing agent for direct oral factor Xa inhibitors? Firstly, there is an overall lower risk of intracranial hemorrhage compared with vitamin K antagonists (VKAs). Atrial fibrillation is increasingly seen as a result of our ageing population, with incidence rising with each decade, from 0.5% in those age 50 to 59 years to almost 9% in those age 80 to 90 years. Their main indication at present, despite growing use in the long-term prevention of both venous and arterial thromboembolisms, is the prevention of stroke in those with atrial fibrillation. DOACs account for a growing proportion of oral anticoagulants prescribed. Not only can andexanet alfa reverse the anticoagulant effects of DOACs that directly inhibit factor Xa (rivaroxaban, apixaban, edoxaban, and betrixaban), but it is also the first reversing agent for low molecular weight heparin (LMWH) and fondaparinux, which both inhibit factor Xa indirectly through antithrombin. ![]()
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