ArticleAnesthesiology2026
Comparing Hemostatic Efficacy of Four-factor Prothrombin Complex Concentrate with Andexanet Alfa in an Apixaban-treated Polytrauma Male Porcine Model.
Article in Anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study directly compared the hemostatic efficacy of two first-line treatments for reversing the effects of direct oral anticoagulants in patients with massive bleeding, andexanet alfa and four-factor prothrombin complex concentrate (4F-PCC), in an apixaban anticoagulated male porcine polytrauma model.
methodsMale pigs (N = 32) received 20 mg/day apixaban for 3 days. Trauma was simulated by inducing standard liver injuries and bilateral femur fractures. After resuscitation, the animals received control, 4F-PCC (25 or 50 U/kg), or andexanet alfa (1,000-mg bolus followed by 1,200-mg infusion over 2 h); n = 8 animals per group. Blood loss, survival, and coagulation parameters were evaluated.
resultsBoth 50 U/kg 4F-PCC and andexanet alfa treatment achieved 100% survival. Blood loss was significantly reduced compared with the control group (mean ± SD 3,843 ± 406 ml), with the largest effects observed for andexanet alfa (1,123 ± 197 ml) followed by 50 U/kg 4F-PCC (1,855 ± 372 ml) and then 25 U/kg 4F-PCC. Consistent with the mechanism of action, andexanet alfa led to significantly lower apixaban anti-factor Xa activity (15.6 ± 6.2 ng/ml) compared with control or 4F-PCC treatment until 180 min after trauma. However, 4F-PCC treatment was able to dose-dependently overcome the trauma-induced reduction in coagulation factors II, VII, IX, and X in contrast to andexanet alfa. While andexanet alfa shortened lag time and increased peak thrombin generation, 4F-PCC dose-dependently improved peak height and endogenous thrombin potential. No thromboembolic complications were observed.
conclusionsIn a male polytrauma porcine model of apixaban anticoagulation, both high-dose 4F-PCC and andexanet alfa were fully effective in achieving survival and hemostatic control. Andexanet alfa achieved hemostasis more rapidly, while 4F-PCC showed sustained restoration of factors II, VII, IX, and X levels, as well as thrombin generation.
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