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Deterioration free discharge comparison of andexanet-alfa and prothrombin complex concentrates (PCC) for reversal of factor Xa inhibitor associated bleeds

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Abstract

Given the paucity of comparative efficacy data and the difference in cost between andexanet-alfa and prothrombin complex concentrates (PCC), debates continue regarding optimal cost-effective therapy for patients who present with major bleeding associated with oral factor Xa inhibitors. Available literature comparing the cost-effectiveness of the reversal agents is limited, and the large difference in price between therapy options has led many health systems to exclude andexanet-alfa from their formularies. To evaluate the clinical outcomes and cost of PCC compared to andexanet-alfa for patients with factor Xa inhibitor associated bleeds. We performed a quasi-experimental, single health system study of patients treated with PCC or andexanet-alfa from March 2014 to April 2021. Deterioration-free discharge, thrombotic events, length of stay, discharge disposition, and cost were reported. 170 patients were included in the PCC group and 170 patients were included in the andexanet-alfa group. Deterioration-free discharge was achieved in 66.5% of PCC-treated patients compared to 69.4% in the andexanet alfa-treated patients. 31.8% of PCC-treated patients were discharged home compared to 30.6% in the andexanet alfa-treated patients. The cost per deterioration-free discharge was $20,773.62 versus $5230.32 in the andexanet alfa and 4 F-PCC group, respectively. Among patients that experienced a bleed while taking a factor Xa inhibitor, there was no difference in clinical outcomes for patients treated with andexanet-alfa compared to PCC. Although there was no difference in the clinical outcomes, there was a significant difference in cost with andexanet-alfa costing approximately four times as much as PCC per deterioration-free discharge.

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Authors and Affiliations

  1. Department of Pharmacy, Henry Ford Health Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI, 48202, USA

    Jason J. Keinath, James S. Kalus & Mathew C. Jones

  2. Syneos Health, Morrisville, USA

    Jona Lekura

  3. Department of Pharmacy, Indiana University Health Methodist Hospital, Indianapolis, IN, USA

    Christian D. Hauser

  4. Department of Pharmacy, Henry Ford Health Wyandotte Hospital, Wyandotte, MI, USA

    Manisha K. Bajwa & Michael E. Bloome

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  1. Jason J. Keinath
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  2. Jona Lekura
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  4. Manisha K. Bajwa
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Contributions

JK, MJ, JL, CH, MB, MB, JK were all involved with designing the methods and revision of the manuscript. JK performed data collection and analyzed the data.

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Correspondence to Jason J. Keinath.

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JJK, MCJ, JL, CDH, MKB, MEB, JSK declare that they have no conflicts of interest.

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Keinath, J.J., Lekura, J., Hauser, C.D. et al. Deterioration free discharge comparison of andexanet-alfa and prothrombin complex concentrates (PCC) for reversal of factor Xa inhibitor associated bleeds. J Thromb Thrombolysis 56, 315–322 (2023). https://doi.org/10.1007/s11239-023-02840-8

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