Introduction
Andexanet alfa (trade name EU: Ondexxya, U.S.: Andexxa) has been approved in Germany since April 2019 for stopping life-threatening or uncontrolled bleeding in adults who are taking the anti-clotting medications apixaban or rivaroxaban.
Anti-clotting medications (blood thinners) are used by people who have a higher risk of thrombosis or thromboembolism. The anti-clotting medications that can be taken in tablet form include medicines called direct oral anticoagulants (DOACs), such as apixaban and rivaroxaban. Apixaban and rivaroxaban work by inhibiting the clotting factor Xa. They are mainly used to treat atrial fibrillation, after the implantation of an artificial heart valve, an artificial knee joint or an artificial hip, or following pulmonary embolism. Their most common side effects include bleeding in various organs. Severe or life-threatening bleeding is very rare, though.
Andexanet alfa is an antidote to apixaban or rivaroxaban, meaning that it stops or counteracts their effects. If major bleeding occurs, andexanet alfa is supposed to stop the anti-clotting effect produced by the drug that inhibits clotting factor Xa (apixaban or rivaroxaban).