Evidence map›Paper›PMID 41406988›Full record

ArticleBritish journal of clinical pharmacology2026

Trends and variation in the use of andexanet alfa for the reversal of direct oral anticoagulants in NHS trusts in England.

Louis Fisher, Richard Buka, Rosalind Byrne, Stephen Black, Helen J Curtis, Christopher Wood, Andrew Brown, Sebastian Bacon, Richard Croker, Ben Goldacre and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–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

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Chemical Synthesis and Biochemical Evaluation of Decasulfated Galloylglucopyranose Heparin Mimetic.Cardiovascular & hematological agents in medicinal chemistry · 2026
    Article
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

12 authors.

Louis FisherBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0002-0295-3812
Richard BukaDepartment of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0002-2738-6236
Rosalind ByrneHaematology, King's Thrombosis Centre, King's College Hospital NHS Foundation Trust, London, UK.ORCID https://orcid.org/0000-0002-4378-8788
Stephen BlackBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0002-7621-9522
Helen J CurtisBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0003-3429-9576
Christopher WoodBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0001-5184-0606
Andrew BrownBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0002-3688-8393
Sebastian BaconBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0002-6354-3454
Richard CrokerBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0002-8114-9186
Ben GoldacreBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0002-5127-4728
Brian MacKennaBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0002-3786-9063
Victoria SpeedBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0001-5064-9375

Funding

A National Institute for Health Research (NIHR) School of Primary Care Research (SPCR) Grant 327National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme PB-PG-0418-20036NHS England Primary Care and Medicines Analytics UnitNIHR Biomedical Research Centre, Oxford, A Health Foundation Grant 7599
6 · The paper itself

Abstract

aimsAndexanet alfa was recommended by the National Institute for Health and Clinical Excellence (NICE) as an option in the management of life-threatening gastrointestinal bleeding in patients taking apixaban or rivaroxaban in May 2021. A recent UK-wide survey of local hospital protocols for the use of andexanet alfa suggested that practice across the United Kingdom is highly variable. In January 2025, NICE was unable to make a recommendation on the use of andexanet alfa for reversing anticoagulation in adults with intracranial haemorrhage. We set out to report trends and variation in the uptake of andexanet alfa across the NHS in England, using the new OpenPrescribing Hospitals platform.

methodsTo assess the uptake of andexanet alfa, we analysed pharmacy stock control data from NHS trusts in England using the openly available Secondary Care Medicines Dataset. Analysis was restricted to NHS trusts with 24-h consultant-led emergency care activity.

resultsBetween May 2021 and June 2025, 19 608 vials of andexanet alfa were issued in NHS trusts in England. There was wide variation in the timing and speed of uptake across NHS trusts. Substantial variation was also observed between NHS Regions in England.

conclusionsThe use of andexanet alfa varies markedly between NHS regions and between NHS trusts in England. This study is the first analysis of adoption of a new treatment using the OpenPrescribing Hospitals platform, which is expected to provide a generalizable framework for similar analyses in the future.

Indexed as

Factor VIIIFactor XaFactor Xa InhibitorsIntracranial HemorrhagesPractice Patterns, Physicians'Administration, OralAnticoagulantsEnglandHumansPyrazolesPyridonesRecombinant ProteinsRivaroxabanState MedicineAnticoagulantsapixabanFactor VIIIFactor XaFactor Xa InhibitorsPRT064445PyrazolesPyridonesRecombinant ProteinsRivaroxabananticoagulant reversal agentsanticoagulantsantidotesthrombosis

Identifiers

PMID41406988
PMCPMC13206202

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.