Concomitant andexanet alfa and 4 F-PCC for Factor Xa inhibitor associated intracranial hemorrhage

Andexanet alfa is the only FDA approved drug for acute reversal of life-threatening bleeding associated with oral factor Xa inhibitor agents. The case series investigates clinical outcomes of four patients receiving concomitant Andexanet alfa and Four Factor Prothrombin Concentrate Complex (4 F-PCC) for acute reversal of intracranial hemorrhage. Following administration, effective hemostasis was achieved in two patients (50%) and one patient (25%) experienced an acute ischemic stroke. Two patients (50%) expired prior to discharge without achieving hemostasis. This case series serves to further expand the limited data on the concomitant administration of Andexanet alfa and 4 F-PCC. •Concomitant use of Andexanet Alfa and 4F-PCC did not provide additional efficacy compared to these agents used alone.•Incidence of thrombotic events and mortality was higher with concomitant use compared to single agent use.•Dose of the two agents did not correlate with safety or efficacy outcomes.