Andexanet alfa is approved for reversal of which anticoagulants, and what is its mechanism of reversal?

• A Heparin and LMWH reversal by ionic binding and neutralization
• B Dabigatran reversal by direct binding and sequestration of dabigatran
• C Warfarin reversal by inducing rapid vitamin K-dependent clotting factor synthesis
• D Rivaroxaban and apixaban (anti-Xa agents) reversal by acting as a decoy factor Xa to bind and sequester the anticoagulant ✓

Explanation

Andexanet alfa is a recombinant modified human factor Xa decoy molecule — it retains high-affinity binding sites for factor Xa inhibitors (rivaroxaban, apixaban, edoxaban, betrixaban) but lacks the catalytic activity of factor Xa and cannot participate in coagulation. It acts as a competitive bait, sequestering anti-Xa anticoagulants from circulation and restoring coagulation. It is not used for heparin reversal (use protamine) or dabigatran reversal (use idarucizumab — specific anti-dabigatran antibody fragment).

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.