Table 5. Comparison of 4F-PCC and... | American Society of Hematology

Table 5.

Comparison of 4F-PCC and andexanet alfa for the reversal of direct factor Xa inhibitors

Reversal agent	4F-PCC	Andexanet alfa
Mechanism of action	Reverses PT and endogenous thrombin generation; indirect, nonspecific pro-hemostatic	Acts as a “decoy” via binding and sequestering the factor Xa inhibitors Direct specific antidote
Dose	50 U/kg for major bleeding or a fixed dose of 2000 U used for simplicity	Dose depends on the dose and timing of the last dose of the FXa inhibitor* Low dose: 400 mg intravenous bolus at 30 mg/min, followed by infusion of 480 mg at 4 mg/min for up to 2 h High dose: 800 mg intravenous bolus at 30 mg/min, followed by infusion of 960 mg 8 mg/min for up to 2 h
Availability	Readily available at most hospitals	Limited availability
Rate of effective management of major bleeding (95% CI)	With the ISTH criteria: 69% (61%-76%) Not using the ISTH criteria: 75% (53%-97%)⁷⁰	83% (75%-89%)⁶⁹
Rate of thromboembolic complications (95% CI)	5% (1%-9%)⁷⁰	11% (NA)⁶⁹
Cost	$1.27† per unit⁷¹ For 2000 U 4F-PCC $2540	$3300 per vial of 100 mg⁷² Low dose (9 vials) $29 700, high dose (18 vials) $59 400

Reversal agent	4F-PCC	Andexanet alfa
Mechanism of action	Reverses PT and endogenous thrombin generation; indirect, nonspecific pro-hemostatic	Acts as a “decoy” via binding and sequestering the factor Xa inhibitors Direct specific antidote
Dose	50 U/kg for major bleeding or a fixed dose of 2000 U used for simplicity	Dose depends on the dose and timing of the last dose of the FXa inhibitor* Low dose: 400 mg intravenous bolus at 30 mg/min, followed by infusion of 480 mg at 4 mg/min for up to 2 h High dose: 800 mg intravenous bolus at 30 mg/min, followed by infusion of 960 mg 8 mg/min for up to 2 h
Availability	Readily available at most hospitals	Limited availability
Rate of effective management of major bleeding (95% CI)	With the ISTH criteria: 69% (61%-76%) Not using the ISTH criteria: 75% (53%-97%)⁷⁰	83% (75%-89%)⁶⁹
Rate of thromboembolic complications (95% CI)	5% (1%-9%)⁷⁰	11% (NA)⁶⁹
Cost	$1.27† per unit⁷¹ For 2000 U 4F-PCC $2540	$3300 per vial of 100 mg⁷² Low dose (9 vials) $29 700, high dose (18 vials) $59 400

CI, confidence interval; NA, not available.

Low dose is used for all patients receiving apixaban and for those receiving rivaroxaban ≥8 h ago. High dose is used for those receiving rivaroxaban <8 h ago or at an unknown time.

†

Price is in USD. Cost of 4F-PCC is lower in Canada and Europe.

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