American College of Gastroenterology Annual Meeting
American College of Gastroenterology Annual Meeting
Perspective from Sunguk Jang, MD
November 19, 2019
3 min read

Andexxa effective in GI bleeds

Perspective from Sunguk Jang, MD
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SAN ANTONIO — Andexxa helped produce high rates of hemostasis in patients with major gastrointestinal bleeding, according to study results presented at the American College of Gastroenterology Annual Meeting.

“[Andexxa (andexanet alfa, Portola) is a recombinant modified human factor Xa molecule that was specifically designed to reverse the effects of factor Xa inhibitor anticoagulants,” Deborah Siegal, MD, MSc, of McMaster University, said in her presentation.

Researchers examined the drug in the ANNEXA-4 trial, a single-arm study comprising 352 patients with acute major bleeding while taking a FXa inhibitor. They included patients with major GI bleeding if they had signs of hemodynamic compromise or bleeding associated with a hemoglobin drop (drop 2 g/dL or baseline Hb 8 g/dL).

After enrollment, patients received one of two andexanet regimens that were based on the type, timing and dose of their most recent inhibitor intake.

The primary endpoints of the study were change in anti-FXa activity and achievement of hemostasis, which was judged by an independent committee 12 hours after treatment and placed into three categories — excellent if the red blood cell transfusion-corrected Hb at 12 hours was no greater than 10% lower than baseline, good if Hb was 10% to 20% lower, and poor/none if Hb was more than 20% lower.

At the time of dosing, the mean Hb was 4.9 ± 1.4 g/dL. Among patients taking Xarelto (rivaroxaban, Janssen), the baseline anti-FXa activity was 267 ± 168.5 ng/mL, and the percent reduction with andexanet was 94% (95% CI, 89%–96%). In patients who received Eliquis (apixaban, Bristol-Myers Squibb, Pfizer) the baseline anti-FXa activity was 244 ± 215.0 ng/mL, and the percent reduction with andexanet was 92% (95% CI, 88%–95%).

Siegal and colleagues found that 85% of patients achieved excellent or good hemostasis after treatment.

In their safety assessment, researchers found that 58 of 62 patients received red blood cell transfusions, three received platelet transfusions and two received coagulation factor product. In the safety population, the 30-day rate of thrombosis was 6% and 13% for death.

“A majority of patients did not restart oral anticoagulants within 30 days of bleeding,” Siegal said. “Which represents an area of critical need.” – by Alex Young


Siegal D, et al. Abstract 53. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.

Disclosures: Siegal reports consulting for Aspen Pharmaceuticals, Bayer, Bristol-Myers Squibb, Leo Pharma, Novartis, Pfizer, Portola Pharmaceuticals and Servier Canada.