Apixaban Reversal Agent, anyone ever have it used? How widely available?

[bayonnejoe1]

I know the lack of a Reversal Agent has been a source of concern, and caused some to avoid, the newer AC meds. The U.S. Food and Drug Administration (FDA) approved Portola Pharmaceuticals' Andexxa, the first antidote indicated for patients treated with rivaroxaban (Xarelto) and apixaban (Eliquis), for reversal of anticoagulation in life-threatening or uncontrolled bleeding situations since May , 2018. Anyone know about it's effectiveness, availability or had knowledge of someone using it?

[BobD Volunteer]

I think most people in the know are not worried about reversal agents as these DOACs have such short half life. Any injury serious enough to need them would be life threatening in any event unles you are lucky enough to have your accident outside a hosiptal. Many people think warfarin is better because of reversal ability but that is really a false premise as Vit K takes time and the chemical which can be used is not generally available other than to emergency and serious trauma staff.

[Hidden]

As BobD says, most of us who take a DOAC don’t really worry about the availability of any reversal agents. Most of us determine which is our highest risk, having a stroke or having a chronic internal bleed. Unless you are subject to hereditary problems or heavy into contact sports or potentially dangerous pursuits, the risk of having a stroke generally wins. DOAC’s offer the same, if not better protection against an internal bleed than warfarin and the reality is that should it be necessary, you are unlikely to be close enough to a suitable health facility for it make a lot of difference. Of course I don’t want to minimise the benefits of having a reversal agent but sometimes we need to be realistic.

[sleeksheep]

I have had quite deep minor surgery while still on Rivaroxaban and the Dr just gives the incision site some adrenaline (epinephrine) which reduces the bleeding to a normal seep , so I have no concerns about any bleeding risk while on DOACs

[bayonnejoe1]

I posted this because I know two people with AF who hesitated in choosing a newer AC because, at the time not to long ago, no reversal agent was available. One went with Warafin, and had issues with it, and the other chose to not use an AC, a dangerous decision imo. I am using, and am very comfortable with Apaxiban. Started before these agents were available. I posted this topic because I didn't see any discussion of reversal agents and because the issue was a deciding factors for two acquaintances. Though it was a non-issue for me, and despite my belief these agents are of minimal worth, I think they may provide some psychological solace to some.

[MarkS]

I don't think Andexxa is widely available in the UK. It is extremely expensive at $26,000 per dose in the US, compared with PCC at about £1,000.

PCC is the rapid reversal agent for warfarin, it takes about 5-10 mins and is widely available, for instance being carried in some air ambulances.

[beardy_chris]

I had a punctured intercostal artery while on Apixaban (don't ask). The A&E consultant told me afterwards that it was no problem and they are used to dealing with DOACs and managing the bleeding without needing reversal agents. He said the availability of a reversal agent is a complete red herring.

Oh and I'm still alive!