Andexanet alfa: administration quick reference guide (Guidelines)
Andexanet alfa must only be administered on the advice of a Consultant Haematologist.
It is used to reverse the effects of rivaroxaban or apixaban in life-threatening or uncontrolled bleeding.
Patients should receive either a LOW DOSE or HIGH DOSE regimen depending on the time/dose of their last oral anticoagulant. Both are given as an initial loading dose (15 to 30 minutes) followed by a 2 hour infusion. See full administration guide for further details.
Low dose regimen = 400mg loading dose followed by 480mg over 2 hours.
High dose regimen = 800mg loading dose followed by 960mg over 2 hours.
|Anticoagulant||Last Dose||Timing of last dose before andexanet alfa administration|
|less than 8 hours or unknown||8 or more hours|
|Rivaroxaban||≤ 10mg||LOW DOSE||LOW DOSE|
|> 10mg or unknown||HIGH DOSE|
|Apixaban||≤ 5mg||LOW DOSE||LOW DOSE|
|> 5mg or unknown||HIGH DOSE|
The volume, doses and rates required for each regimen is detailed below. Andexanet alfa comes as a 200mg/20mL vial (pack size of 4 vials). Dedicated syringe pumps with the loading and maintenance rates pre-programmed are available in each location andexanet is stocked, but as an additional safety measure these should be checked against the table below.
|Low dose regimen||High dose regimen|
|Loading dose||Maintenance infusion||Loading dose||Maintenance infusion|
|Dose and millimetres required||400mg in 40mL||480mg in 48mL||800mg in 80mL||960mg in 96mL|
|Vials required||2||3 (discard remainder of vial 3)||4||5 (discard remainder of vial 5)|
|50mL syringes required||One||One||Two = 40mL per syringe||Two = 48mL per syringe|
|Rate of administration via syringe pump||160mL/hr (bolus dose over 15 minutes)||24mL/hr (over 2 hours)||160mL/hour (over 30 minutes; each syringe will run for 15 minutes each)||48mL/hr (over 2 hours; each syringe will run for 60 minutes each)|
Once andexanet alfa has been administered please complete this form as soon as possible.