The use of direct oral anticoagulants over traditional warfarin has increased in 
the United States over the past 10 years because of advantages such as ease of 
use, predictable pharmacokinetic response, and safety. In 2015, the U.S. Food 
and Drug Administration approved idarucizumab (Praxbind) for the reversal of the 
direct thrombin inhibitor dabigatran, but no reversal agent has been available 
for oral factor Xa (FXa) inhibitors until recently. Andexanet alfa was approved 
in May 2018, under the brand name ANDEXXA, for the reversal of 2 of FXa 
inhibitors, apixaban and rivaroxaban, when life-threatening or uncontrolled 
bleeding occurs. This accelerated approval was based on change in anti-FXa 
activity from baseline that indicated a reversal of the anticoagulant effect. 
Any expanded Food and Drug Administration indication will be contingent on 
results demonstrating improved hemostasis and efficacy for reversing other FXa 
inhibitors.