ArticleResearch and practice in thrombosis and haemostasis2023
Lower mortality with andexanet alfa vs 4-factor prothrombin complex concentrate for factor Xa inhibitor-related major bleeding in a U.S. hospital-based observational study.
Article in Research and practice in thrombosis and haemostasis, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05548777 (Andexanet Alfa and 4F-PCC Use in Patients Hospitalised With an Anticoagulant-related Major Bleed), which is not on this map. Cited by 23 papers, 1 of them a synthesis that pooled 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.
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.
Andexanet Alfa and 4F-PCC Use in Patients Hospitalised With an Anticoagulant-related Major Bleed
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Efficacy and Safety of Andexanet Alfa Versus Four Factor Prothrombin Complex Concentrate for Emergent Reversal of Factor Xa Inhibitor Associated Intracranial Hemorrhage: A Systematic Review and Meta-Analysis.Neurocritical care · 2025Pooled it
- Treatment of Antithrombotic-Associated Intracranial Hemorrhage in Adults: A Focused Guideline Update from the Neurocritical Care Society and the Society of Critical Care Medicine.Neurocritical care · 2026Article
- Hospital Course and Outcomes After Major Bleeding in Patients on Factor Xa Inhibitors in Japan: A Nationwide Observational Study.Journal of atherosclerosis and thrombosis · 2026Observational
- Comparing Hemostatic Efficacy of Four-factor Prothrombin Complex Concentrate with Andexanet Alfa in an Apixaban-treated Polytrauma Male Porcine Model.Anesthesiology · 2026Article
- Use of andexanet alfa: A British Society for Haematology position statement.British journal of haematology · 2026Article
- A UK-wide analysis of the use of reversal agents in 198 patients on direct oral anticoagulants prior to urgent procedures.Research and practice in thrombosis and haemostasis · 2026Article
- Incidence and outcomes of major bleeding among first-time oral factor Xa inhibitor users: multinational observational cohort studies.Research and practice in thrombosis and haemostasis · 2026Article
- Andexanet alfa vs standard of care for factor Xa inhibitor-induced intracranial hemorrhage-a systematic review and meta-analysis.Research and practice in thrombosis and haemostasis · 2025Review
- Andexanet alfa in patients with factor Xa inhibitor-associated intracranial hemorrhage: The prospective observational multicenter ASTRO-DE study.International journal of stroke : official journal of the International Stroke Society · 2025Observational
- Multidisciplinary Expert Guidance for the Management of Severe Bleeding on Oral Anticoagulation: An Algorithm for Practicing Clinicians.Thrombosis and haemostasis · 2025Review
- Andexanet Alfa in Urgent Cardiac Surgery: A Case Report of Edoxaban Reversal for Acute Hemopericardium.The American journal of case reports · 2025Article
- Reversal of Direct Oral Anticoagulants (DOACs) for Critical Bleeding or Urgent Procedures.Journal of clinical medicine · 2025Review
- Position statement of the Polish Society of Gastroenterology on the use of andexanet alfa in patients with gastrointestinal bleeding taking factor Xa inhibitors.Przeglad gastroenterologiczny · 2025Article
- Real-world andexanet alfa utilization and the association between delay in administration due to hospital transfer and all-cause inpatient mortality.Research and practice in thrombosis and haemostasis · 2025Article
- Management of factor Xa inhibitor-related traumatic non-intracranial bleeding events with andexanet alfa or four-factor prothrombin complex concentrate in a US multicenter observational study.Journal of the American College of Emergency Physicians open · 2024Article
- Urgent Reversal of Direct Oral Anticoagulants in Critical and Life-Threatening Bleeding: A Multidisciplinary Expert Consensus.Journal of clinical medicine · 2024Review
- Andexanet Alfa versus Four-Factor Prothrombin Complex Concentrate for the Reversal of Factor Xa (FXa) Inhibitor-Associated Intracranial Hemorrhage: A Systematic Review of Retrospective Studies.Journal of clinical medicine · 2024Review
- Reply to "Letter to Dobesh et al. on lower mortality with andexanet alfa in factor Xa inhibitor-related major bleeding".Research and practice in thrombosis and haemostasis · 2024Article
- Letter to Dobesh et al. on lower mortality with andexanet alfa in factor Xa inhibitor-related major bleeding.Research and practice in thrombosis and haemostasis · 2024Article
- Clinical Characteristics and Incidence of Hemorrhagic Complications in Patients Taking Factor Xa Inhibitors in Spain: A Long-Term Observational Study.Journal of clinical medicine · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Well-designed studies with sufficient sample size comparing andexanet alfa vs 4-factor prothrombin complex concentrate (4F-PCC) in routine clinical practice to evaluate clinical outcomes are limited. Objectives: To compare in-hospital mortality in patients hospitalized with rivaroxaban- or apixaban-related major bleeding who were treated with andexanet alfa or 4F-PCC. Methods: An observational cohort study (ClinicalTrials.gov identifier: NCT05548777) was conducted using electronic health records between May 2018 and September 2022 from 354 U.S. hospitals. Inclusion criteria were age ≥18 years, inpatient admission with diagnosis code D68.32 (bleeding due to extrinsic anticoagulation), a record of use of the factor Xa inhibitors rivaroxaban or apixaban, andexanet alfa or 4F-PCC treatment during index hospitalization, and a documented discharge disposition. Multivariable logistic regression on in-hospital mortality with andexanet alfa vs 4F-PCC was performed. The robustness of the results was assessed via a supportive propensity score-weighted logistic regression. Results: The analysis included 4395 patients (andexanet alfa, Conclusion: In this large observational study, treatment with andexanet alfa in patients hospitalized with rivaroxaban- or apixaban-related major bleeds was associated with 50% lower odds of in-hospital mortality than 4F-PCC. The magnitude of the risk reduction was similar in ICH and GI bleeds.
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Registered trials
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.