par Motte, Serge 
Référence Revue médicale de Bruxelles, 44, 5, page (501-503)
Publication Publié, 2023-10
Référence Revue médicale de Bruxelles, 44, 5, page (501-503)
Publication Publié, 2023-10
Article révisé par les pairs
| Résumé : | Andexanet alfa (Ondexxya®) is a recombinant factor Xa molecule with a high affinity for factor Xa inhibitors and has been authorised in the European Union as an antidote for severe bleeding in patients taking apixaban or rivaroxaban. Andexanet alfa has been evaluated in a prospective cohort study that included 479 patients mostly treated with apixaban or rivaroxaban and who had acute major bleeding. The antidote was administered intravenously to all patients. Anti-Xa activity was reduced by 93% and 94% in patients treated with apixaban and rivaroxaban respectively. Haemostatic efficacy 12 hours after treatment was considered excellent or good in 80% of evaluable patients. The 30-day mortality for the overall population was 15,7% and a thromboembolic event occurred in 10% of patients. In the absence of a control group, the results of the cohort study do not indicate whether andexanet alfa improved patient prognosis. In addition, if the biological efficacy of andexanet alfa is immediate, a rebound effect related to the short half-life of this antidote was observed upon discontinuation of the infusion. This rapid loss of effect raises questions in case of urgent invasive procedures requiring prolonged correction of hemostasis. |
