Active Research

New Research  =>  Reversal agent for new blood thinners  =>  Andexanet


Suspect acute bleeding in a patient is taking one of the following medications???

  • Rivaroxiban (Xarelto)
  • Apixaban (Eliquis)
  • Enoxaparin (Lovenox)


– The Christ Hospital now has the following treatment available through the Annexa Study –


  • This drug is a reversal agent for Factor Xa inhibitors, a new class of anticoagulants
  • It is used to immediately reverse anticoagulation in patients with ACUTE BLEEDING
  • Reversal of anticoagulation in the event of an acute bleeding episode shows a reduction in mortality
  • Acute bleeding that is potentially life threatening includes:
    1. GI bleeds
    2. Intracranial hemorrhage
    3. Intraspinal, retroperitoneal or intramuscular with compartment syndrome
    4. Bleeding associated with a drop in the Hb level >2g/dL or a Hb < 8g/dL
  • The study drug must be started within 18 hours of the last dose of Factor Xa inhibitors
  • Patients will receive an IV bolus of Andexanet followed by a 2 hour infusion
  • The most common side effect is a mild transfusion reaction (sensation of warmth, flushing, palpitations) which generally last only minutes and subsides without intervention

How can EMS assist in this process?

  • By identifying patients with ACUTE BLEEDING episodes who are taking:
  • Rivaroxiban (Xarelto)
  • Apixaban (Eliquis)
  • Enoxaparin (Lovenox)
  • Document the drug name, time of last dose, and amount of last dose
  • If possible, notify the Emergency Department so that they can call the Research Team