How do you reverse bleeding with Xarelto?

Andexxa injection is an antidote that can be used for patients being treated with rivaroxaban (Xarelto) or apixaban (Eliquis) when reversal of anticoagulation (blood thinning) is needed due to life-threatening or uncontrolled bleeding.

Andexxa (coagulation factor Xa), from Portola Pharmaceuticals, is a Factor Xa inhibitor reversal agent approved in 2018. It is an altered form of the human Factor Xa (10a) molecule, a human enzyme that helps blood to clot and lowers the risk from serious bleeding from Xa inhibitors. It is given as an intravenous (IV) injection.

The most common side effect with Xarelto is bleeding. You may bruise easily or take longer to stop bleeding from a minor cut.

Get medical help immediately if you have:

• Frequent nose bleeds or bleeding gums
• Heavy menstrual or vaginal bleeding
• Uncontrollable bleeding or unexpected bruising
• Red, pink or brown urine
• Bright red or black, tarry stools
• Coughing up blood or vomit looks like “coffee grounds”
• Headaches, dizzy or weak
• Pain, swelling

Vitamin K is often used to reverse bleeding from warfarin but doesn't work for drugs like Xarelto.

How does Andexxa work to stop bleeding?

Andexxa works by acting as a trap for oral and injectable Factor Xa inhibitors, binding to the drug to reverse the anticoagulant effect. It ​​neutralizes the anticoagulant effect of Xarelto (rivaroxaban). Andexxa is also approved to reduce the anticoagulant effect of Factor Xa inhibitor Eliquis (apixaban).

• In a Phase 3 studies in healthy volunteers, Andexxa rapidly and significantly reversed anti-Factor Xa activity within 2 minutes after a bolus injection and sustained these reductions throughout the 2-hour continuous infusion.
• The median decrease in anti-Factor Xa activity from baseline was 97% for rivaroxaban (Xarelto) and 92% for apixaban (Eliquis).
• In another study with 234 patients who experienced a major bleed while taking Xarelto or Eliquis, Andexxa, reversed blood thinning by 93%

The most common adverse reactions (side effects) with Andexxa were:

• Urinary tract infections and pneumonia (≥ 5% in bleeding subjects)
• Infusion-related reactions (≥ 3% in healthy volunteers)

Andexxa can cause serious or life-threatening side effects, including the development of blood clots. Talk to your doctor about when to restart your blood thinner medication to help reduce the risk of a blood clot formation.

Andexxa is given in 2 parts as a bolus first (an injection that gets the medicine into your bloodstream quickly) and as an infusion second (slowly adds the medicine to your bloodstream over time. It is given only by your doctor or other healthcare provider.

• Related: Dosing for Andexxa (in detail)

This is not all the information you need to know about Andexxa and does not take the place of your doctor’s directions. Discuss any medical questions you have with your doctor or other health care provider.

Related questions

• What foods should I avoid while on Eliquis?
• Top 6 Eliquis Side Effects: What You Need to Know in Depth
• Xarelto vs Eliquis: How do they compare?