Evidence map›Paper›PMID 31664662›Full record

Trial reportJournal of thrombosis and thrombolysis2020

Cost comparison of andexanet versus prothrombin complex concentrates for direct factor Xa inhibitor reversal after hemorrhage.

Jennifer A Frontera, Prachi Bhatt, Rebecca Lalchan, Shadi Yaghi, Tania Ahuja, John Papadopoulos, Danielle Joset

Abstract readClinical TrialComparative Study
PubMed Publisher
In one paragraph

Trial report in Journal of thrombosis and thrombolysis, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Article
  7. Observational
  8. Review
  9. Article
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  12. Article
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  14. Article
  15. Article
  16. Improving Patient Safety Through Proper Ordering and Administration of Andexanet Alfa.Mayo Clinic proceedings. Innovations, quality & outcomes · 2024
    Article
  17. Article
  18. Article
  19. Review
  20. Massive Trauma and Resuscitation Strategies.Anesthesiology clinics · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Jennifer A FronteraDepartment of Neurology, NYU School of Medicine, New York, NY, USA. jennifer.frontera@nyulangone.org.
Prachi BhattDepartment of Pharmacy, NYU Langone Health, New York, NY, USA.
Rebecca LalchanDepartment of Neurology, NYU School of Medicine, New York, NY, USA.
Shadi YaghiDepartment of Neurology, NYU School of Medicine, New York, NY, USA.
Tania AhujaDepartment of Pharmacy, NYU Langone Health, New York, NY, USA.
John PapadopoulosDepartment of Pharmacy, NYU Langone Health, New York, NY, USA.
Danielle JosetDepartment of Pharmacy, NYU Langone Health, New York, NY, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Andexanet-alpha is a specific reversal agent for direct factor Xa inhibitors (dFXaI). We aimed to project utilization rates and cost of andexanet for reversal of dFXaI-related major hemorrhage compared to 4-factor prothrombin complex concentrates (4F-PCC). A retrospective, multicenter review was conducted between 1/1/2014 and 7/15/2018 of patients who received 4F-PCC for reversal of dFXaI-related life-threatening hemorrhages. Total hospital reimbursements/patient were calculated based on national average MS-DRG payments adjusting for Medicare discounts. The projected cost for andexanet (based on dose and insurance) and % reimbursement/patient was compared to the actual cost of 4F-PCC. Hemostasis at 24 h (excellent/good vs. poor) and 30-day thrombotic complications were assessed. Of 126 patients who received 4F-PCC to reverse dFXaI, 46 (~ 10 per-year) met inclusion criteria. The median projected cost of andexanet was $22,120/patient, compared to $5670/patient for 4F-PCC (P < 0.001). The median hospital reimbursement was $11,492/hospitalization. The projected cost of andexanet alone would exceed the entire hospital reimbursement in 74% of patients by a median of $7604, while 4F-PCC cost exceeded the total hospital payments in 7% of patients in the same cohort (P < 0.001). Hemostasis was excellent/good in 72% of patients post-4F-PCC, compared to 82% in andexanet trials. Thromboembolic events occurred in 4% of patients following 4F-PCC versus 10% in andexanet trials. The projected cost of andexanet would exceed the national average hospital reimbursement/patient in nearly 75% of patients by over $7500/hospitalization. 4F-PCC was significantly less expensive, had lower rates of thrombosis, but also lower rates of good/excellent hemostasis compared to published data for andexanet.

Indexed as

Blood Coagulation FactorsFactor XaFactor Xa InhibitorsHemorrhageRecombinant ProteinsAgedAged, 80 and overCosts and Cost AnalysisFemaleHumansMaleRetrospective StudiesTertiary Care CentersBlood Coagulation FactorsFactor XaFactor Xa Inhibitorsprothrombin complex concentratesPRT064445Recombinant ProteinsAnticoagulationCoagulopathyCostDirect factor Xa inhibitorDOACHemostasisIntracranial hemorrhageNOACReversalThrombosis

Identifiers

PMID31664662

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.