Literature Review of Fixed and Weight-Based Dosing of 4-Factor Prothrombin Complex Concentrate in Achievement of Hemostasis in Adult Patients Taking Factor Xa Direct Oral Anticoagulants
by Ivy Cannella, 2022 PharmD Candidate, Carolyn Villareal, PharmD, BCPS
"Major bleeding is an unfortunate risk of anticoagulation therapy. Currently, andexanet alfa is the only approved agent for reversal of factor Xa DOACs.1 Other agents, including 4F-PCC, have been used off-label for the reversal of DOACs in the setting of major bleeding. Factor Xa DOACs, which include rivaroxaban, apixaban, edoxaban, and betrixaban, target Xa to block the coagulation cascade. 4F-PCC can be used as a reversal agent because it contains coagulation factors II, VII, IX, and X, as well as proteins C and S.2 An additional benefit to using 4F-PCC over other approved reversal agents is a significant cost savings. Wilsey et al. calculated the cost of a dose of andexanet alfa to be $58,080, a 50 unit/kg dose of 4F-PCC to be $6,885, and a 25 unit/kg dose of 4F-PCC to be $3,443 for an 85-kg patient.3"
Keywords: Edoxaban, Factor Xa, Rivaroxaban, Warfarin, Pharmacists, Apixaban, Betrixaban, Cost Savings, Off-Label Use, Wisconsin, Blood, Coagulation Factors, Hemorrhage, Anticoagulants
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2022 March/April Table of Contents
"Major bleeding is an unfortunate risk of anticoagulation therapy. Currently, andexanet alfa is the only approved agent for reversal of factor Xa DOACs.1 Other agents, including 4F-PCC, have been used off-label for the reversal of DOACs in the setting of major bleeding. Factor Xa DOACs, which include rivaroxaban, apixaban, edoxaban, and betrixaban, target Xa to block the coagulation cascade. 4F-PCC can be used as a reversal agent because it contains coagulation factors II, VII, IX, and X, as well as proteins C and S.2 An additional benefit to using 4F-PCC over other approved reversal agents is a significant cost savings. Wilsey et al. calculated the cost of a dose of andexanet alfa to be $58,080, a 50 unit/kg dose of 4F-PCC to be $6,885, and a 25 unit/kg dose of 4F-PCC to be $3,443 for an 85-kg patient.3"
Keywords: Edoxaban, Factor Xa, Rivaroxaban, Warfarin, Pharmacists, Apixaban, Betrixaban, Cost Savings, Off-Label Use, Wisconsin, Blood, Coagulation Factors, Hemorrhage, Anticoagulants
Download PDF
2022 March/April Table of Contents