Perioperative management of patients with hip fracture patients receiving oral anticoagulants requires navigating the risks associated with surgical delay and perioperative hemostasis. 4F-PCC was significantly less expensive, had lower rates of thrombosis, but also lower rates of good/excellent hemostasis compared to published data for andexanet. The projected cost of andexanet would exceed the national average hospital reimbursement/patient in nearly 75% of patients by over $7500/hospitalization. Thromboembolic events occurred in 4% of patients following 4F-PCC versus 10% in andexanet trials. Hemostasis was excellent/good in 72% of patients post-4F-PCC, compared to 82% in andexanet trials. The projected cost of andexanet alone would exceed the entire hospital reimbursement in 74% of patients by a median of $7604, while 4F-PCC cost exceeded the total hospital payments in 7% of patients in the same cohort (P < 0.001). The median hospital reimbursement was $11,492/hospitalization. The median projected cost of andexanet was $22,120/patient, compared to $5670/patient for 4F-PCC (P < 0.001). Of 126 patients who received 4F-PCC to reverse dFXaI, 46 (~ 10 per-year) met inclusion criteria. poor) and 30-day thrombotic complications were assessed. The projected cost for andexanet (based on dose and insurance) and % reimbursement/patient was compared to the actual cost of 4F-PCC. Total hospital reimbursements/patient were calculated based on national average MS-DRG payments adjusting for Medicare discounts. A retrospective, multicenter review was conducted between and of patients who received 4F-PCC for reversal of dFXaI-related life-threatening hemorrhages. We aimed to project utilization rates and cost of andexanet for reversal of dFXaI-related major hemorrhage compared to 4-factor prothrombin complex concentrates (4F-PCC).

Andexanet-alpha is a specific reversal agent for direct factor Xa inhibitors (dFXaI).

Xa inhibitor reversal