![]() Keywords andexanet alfa, anticoagulants, unfractionated heparin, enoxaparin, pentasaccharide, fondaparinux Date received: 16 September 2019 revised: 3 November 2019 accepted: 21 November 2019. However, andexanet alfa is incapable of neutralizing the anti-Xa effects of fondaparinux. These results indicate that andexanet alfa is capable of dif- ferentially neutralizing anticoagulant and antiprotease effects of UFH and enoxaparin in an assay-dependent manner. All agents produced varying degrees of the inhibition of thrombin generation, which were differentially neutralized by andexanet alfa. In the anti-Xa and anti-IIa assays, UFH exhibited partial neutralization whereas enoxaparin and fondaparinux did not show any neutralization. Enoxaparin produced milder anticoagulant responses that were partially neutralized, whereas fondaparinux did not produce any sizeable effects. In the ACT, aPTT, and TT, UFH produced strong anticoagulant effects that were almost completely neutralized by andexanet alfa. In the TEG, andexanet alfa produced almost a complete reversal of the anticoagulant effects of UFH and enoxaparin however, it augmented the effects of fondaparinux. Reversal of each of these agents was studied by supplementing andexanet alfa at 100 mg/mL. ![]() Thrombin generation inhibition was studied using the calibrated automated thrombogram system. The anticoagulant profile of UFH, enoxaparin, and fondaparinux was studied using the activated partial thromboplastin time (aPTT), thrombin time (TT), and amidolytic anti-Xa, and anti-IIa methods. Whole blood clotting studies were carried out using thromboelastography (TEG) and activated clotting time (ACT). ![]() This study focused on the neutralization profiles of unfractionated heparin (UFH), enoxaparin, and, a chemically synthetic pentasaccharide, fondaparinux by andexanet alfa. Andexanet alfa is also reported to neutralize the effects of heparin-related drugs. Siddiqui, Fakiha Tafur, Alfonso Bontekoe, Emily Iqbal, Omer Jeske, Walter Mehrotra, Siddharth Hoppensteadt, Debra Ramacciotti, Eduardo Fareed, JawedĪndexanet alfa is a recombinant factor Xa decoy protein, designed to reverse bleeding associated with oral anti-Xa agents. Assay-Based Differentiation in the Neutralization Profile of Unfractionated Heparin, Enoxaparin, and Fondaparinux by Andexanet Alfa Assay-Based Differentiation in the Neutralization Profile of Unfractionated Heparin, Enoxaparin. ![]()
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