Identify appropriate patients1

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Know the facts

More than 400 patients a day are hospitalized with an apixaban- or rivaroxaban-related bleed. As prescriptions for these direct oral anticoagulants increase, the potential for serious bleeding admissions grows.2-4

Here are some facts about these patients:

  • In nonvalvular atrial fibrillation clinical trials, 45% of apixaban patients (ARISTOTLE Trial*) and 48% of rivaroxaban patients (ROCKET AF Trial) with intracranial hemorrhage died within 30 days5,6
  • In a prospective, multicenter observational study substantial hematoma expansion (defined as a volume increase of ≥33% or ≥6 mL) occurred in approximately 40% of intracerebral hemorrhage patients taking direct oral anticoagulants (DOACs)‡8
  • Gastrointestinal bleeds account for 39%-56% of all bleeding events in apixaban- and rivaroxaban-treated patients*†9,10

*ARISTOTLE study design: Based on a double-blind, double-dummy, randomized clinical trial comparing apixaban with warfarin in patients with AF (N=18,201).5 ROCKET AF study design: Based on a multinational, randomized, double-blind, double-dummy clinical trial comparing rivaroxaban with warfarin in patients with atrial fibrillation (AF) (N=14,264).6
RASUNOA study design: Based on a prospective, multicenter, observational substudy of patients with nontrumatic DOAC-related intracerebral hemorrahage (n=45).8

Meet some typical patients for ANDEXXA®

Patient stories are based on actual cases; however, images are non-patient models.

Linda | 70 | Taking rivaroxaban


Linda slipped on her stairs at home. She didn’t think she was severely injured until later that night.

  • Presented at the ER at ~5 AM, feeling dizzy and exhibiting facial bruising
  • Takes rivaroxaban (10 mg, last taken at ~9:30 PM, ~ 7.5 hours prior to ER arrival) for deep vein thrombosis (DVT) and atorvastatin for hyperlipidemia
  • Transported to the ER by a family member
  • Presented with impairment in spatial perception and stability
  • Also showed visible facial bruising and left arm and left leg weakness
  • Vitals:
    • Blood pressure: 150/90 mmHg
    • Heart rate: 90
    • Respiratory rate: 22
    • Glasgow coma scale: 12 (4/4/4)
  • Preliminary diagnosis: suspected DOAC-related hematoma
  • CT scan of head revealed, in its largest segment, a 10-mm subdural hemorrhage with 3-mm midline shift

For patients like Linda, consider ANDEXXA

Primary diagnosis:
Subdural hemorrhage

Treatment plan:

  • Get high blood pressure under control
  • Reverse rivaroxaban-related anticoagulation with a low dose of ANDEXXA1
  • Admit to intensive care unit11
  • Repeat CT scan per medical judgment12
Download Linda's Full Story

Michael | 61 | Taking apixaban


Arriving home after dinner out with his wife, Michael suddenly had trouble forming words.

  • Presented at the ER with expressive aphasia and intense headache
  • Takes apixaban (5 mg, last taken ~8 hours prior to ER arrival) for nonvalvular atrial fibrillation and amlodipine for hypertension
  • Transported to the ER by a family member
  • Was poorly responsive upon arrival in ER
  • Intubated in ER to protect airway
  • Vitals:
    • Blood pressure: 180/80 mmHg
    • Heart rate: 110
    • Glasgow coma scale: 12 (4/3/5) upon presentation, then declined to 8 (2/1/5), leading to intubation
  • Preliminary diagnosis: suspected DOAC-related hematoma
  • CT scan of head revealed primary intraparenchymal bleed; volume of 15 cc in lobar ICH in the left temporal lobe

For patients like Michael, consider ANDEXXA

Primary diagnosis:
Intracerebral hemorrhage

Treatment plan:

  • Get high blood pressure under control
  • Reverse apixaban-related anticoagulation with a low dose of ANDEXXA1
  • Repeat CT scan of head in 6 hours7
  • Evaluate for possible secondary cause(s) of intracerebral hemorrhage
Download Michael's Full Story

1. Andexxa (prescribing information). Boston, MA: Alexion Pharmaceuticals, Inc.; 2021. 2. Truven Bleeding Events Report: Commercial, Medicare & Medicaid Populations, August 16, 2016. 3. Truven Health Analytics, DOAC Market Data Report. Data month ending November 2018. 4. Truven Health Analytics, DOAC Market Data Report. Data month ending September 2019. 5. Held C, Hylek EM, Alexander JH, et al. Clinical outcomes and management associated with major bleeding in patients with atrial fibrillation treated with apixaban or warfarin: insights from the ARISTOTLE trial. Eur Heart J. 2015;36(20):1264-1272. 6. Hankey GJ, Stevens SR, Piccini JP, et al; for the ROCKET AF Steering Committee and Investigators. Intracranial hemorrhage among patients with atrial fibrillation anticoagulated with warfarin or rivaroxaban: the rivaroxaban once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation. Stroke. 2014;45(5):1304-1312. 7. Melmed KR, Lyden P, Gellada N, et al. Intracerebral hemorrhagic expansion occurs in patients using non-vitamin K antagonist oral anticoagulants comparable with patients using warfarin. J Stroke Cerebrovasc Dis. 2017;26(8):1874-1882. 8. Purrucker JC, Haas K, Rizos T, et al. Early clinical and radiological course, management, and outcome of intracerebral hemorrhage related to new oral anticoagulants. JAMA Neurol. 2016;73:169-177. 9. Eliquis [prescribing information]. Princeton, NJ: Bristol-Myers Squibb Company, and New York, NY: Pfizer Inc.; 2019. 10. Xarelto [prescribing information]. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2020. 11. Nates JL, Nunnally M, Kleinpell R, et al. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med. 2016;44(8):1553-1602. 12. Connolly SJ, Crowther M, Eikelboom JW, et al. Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med. 2019;380:1326-1335