Open Journal Systems

Review of Andexanet alfa and implications for global health

Ralf Jadoopat


Direct oral anticoagulants continue to be frequently utilized in various healthcare settings. As such, reversal agents for these medications are being investigated and are making their way into the market. Andexanet alfa is a reversal agent that was manufactured by Portola Pharmaceuticals and FDA-approved in May of 2018 for reversal of rivaroxaban and apixaban. This article discusses the mechanism of action, dosing, costs, safety, and efficacy of andexanet alfa as well as its potential for improving global health.


Andexanet alfa; Reversal agent; Anticoagulants reversal agent,


Andexxa® [package insert on the internet]. South San Francisco (CA): Portola Pharmaceuticals, Inc; 2017 [cited 2018 Dec 11]. Available from:

Lexicomp Online [Internet]. Hudson (OH): Wolters Kluwer, Inc. c1978-2018. Andexanet alfa [updated 2018 Oct 29; cited 2018 Dec 11]. Available from:

IBM Micromedex [Internet]. Ann Arbor (MI): Truven Health Analytics, Inc. c2018. Red Book [cited 2018 Dec 12]. Available from:

Siegal DM, Curnutte JT, Connolly SJ, et al. Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med [Internet]. 2015 Dec 17 [cited 2018 Dec 11]; 373:2413-24. Available from:

Connolly SJ, Milling TJ, Eikelboom JW, et al. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med [Internet]. 2016 Sep 22 [cited 2018 Dec 11]; 375:1131-41. Available from:

Heo YA. Andexanet Alfa: First Global Approval. Drugs [Internet]. 2018 July [cited 2018 Dec 12]; 78(10):1049-55. Available from:

Portola Pharmaceuticals [Internet]. South San Francisco (CA): Portola Pharmaceuticals, Inc;c2018. CHMP Extends Review Period for Portola Pharmaceuticals’ Ondexxya™ (andexanet alfa); 2018 Dec 11 [cited 2018 Dec 12]; [about 2 screens]. Available from:

Full Text: PDF

Article Level Metrics


  • There are currently no refbacks.