Evidence-Based Minireview: Mortality and thrombosis in patients receiving prothrombin complex concentrates or andexanet alfa for the management of direct oral factor Xa inhibitor-associated major bleeding

Hematology Am Soc Hematol Educ Program. 2019 Dec 6;2019(1):204-208. doi: 10.1182/hematology.2019000074.


A 77-year-old man with atrial fibrillation and a CHA2DS2Vasc score of 6 for hypertension, age, diabetes, and previous stroke is brought to the emergency department with decreased level of consciousness. He is anticoagulated with rivaroxaban (a direct oral factor Xa inhibitor [FXaI]) and received his last dose about 4 hours before presentation. Urgent computed tomography of the head shows intracerebral hemorrhage. Because of his previous stroke, the patient's family is concerned about treating the bleed with pharmacological agents that may increase the risk of stroke. What are the risks of thrombosis and mortality related to the use of prothrombin complex concentrates (PCCs) and andexanet alfa for patients with direct oral FXaI-associated major bleeding?

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Blood Coagulation Factors / adverse effects*
  • Clinical Trials as Topic
  • Factor Xa / adverse effects*
  • Factor Xa Inhibitors / adverse effects*
  • Hemorrhage / chemically induced*
  • Humans
  • Male
  • Recombinant Proteins / adverse effects*
  • Thrombosis / chemically induced*
  • Thrombosis / mortality*


  • Blood Coagulation Factors
  • Factor Xa Inhibitors
  • PRT064445
  • Recombinant Proteins
  • prothrombin complex concentrates
  • Factor Xa