Andexanet alfa (Andexxa®), a first-in-class recombinant modified factor Xa 
protein, is currently the only specific agent available to reverse 
life-threatening or uncontrolled bleeding with the factor Xa inhibitors apixaban 
and rivaroxaban. Andexanet alfa acts as a decoy and competes with endogenous 
factor Xa to bind factor Xa inhibitors, thereby reversing the anticoagulant 
effects of factor Xa inhibitors, and restoring the activity of endogenous factor 
Xa. In adults with major bleeding associated with the use of apixaban or 
rivaroxaban, intravenous administration of andexanet alfa effectively and 
rapidly reduces anti-factor Xa levels, with reduced levels being maintained 
during continued treatment. The tolerability profile of andexanet alfa in 
patients is generally similar to that reported of other approved anticoagulation 
reversal agents. With the known increased risk of thromboembolic events 
following andexanet alfa treatment, anticoagulant therapy should be resumed as 
soon as medically appropriate.