{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:01:34Z","timestamp":1784548894353,"version":"3.55.0"},"reference-count":36,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T00:00:00Z","timestamp":1708041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T00:00:00Z","timestamp":1708041600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hosp Pharm"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>\n                    <jats:bold>Objective:<\/jats:bold>\n                    Andexanet alfa is approved for the reversal of life-threatening or uncontrolled bleeding due to factor-Xa inhibitors. Data are limited on outcomes for patients who receive both andexanet alfa and 4-factor prothrombin complex concentrate (4F-PCC). The aim of this case series is to evaluate the safety and efficacy outcomes in patients receiving the two agents in combination.\n                    <jats:bold>Methods:<\/jats:bold>\n                    Electronic medical records of patients who received both 4F-PCC and andexanet alfa for nontraumatic intracranial hemorrhage from January 2019 to March 2022 were retrospectively reviewed. Hemostatic efficacy and complications related to concurrent use of 4F-PCC with andexanet alfa were documented.\n                    <jats:bold>Results:<\/jats:bold>\n                    Nine patients received 4F-PCC and andexanet alfa for reversal of factor Xa inhibitor-associated intracranial bleeding, eight of whom required reversal of apixaban. Of these nine patients, five patients died within 28\u2009days for a 56% incidence of mortality. The average time from 4F-PCC administration to andexanet alfa administration was 3\u2009hours and 9\u2009minutes. Most doses of andexanet alfa were given for concern for bleed expansion after 4F-PCC administration. Hemostatic efficacy based on stability of repeat computed tomography scans post-administration of both agents was found in six patients (66.67%), with a 55.56% n incidence of thromboembolism, including two pulmonary embolisms, two deep vein thromboses, and one renal artery thrombosis.\n                    <jats:bold>Conclusion<\/jats:bold>\n                    : Risks and benefits should be weighed to determine if there is benefit to adding andexanet alfa to 4F-PCC in patients with incomplete hemostasis and life-threatening hemorrhage. The combination of andexanet alfa and 4F-PCC may increase the risk of thrombotic complications without improving mortality.\n                  <\/jats:p>","DOI":"10.1177\/00185787241229192","type":"journal-article","created":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T02:20:20Z","timestamp":1708136420000},"page":"394-406","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Co-administration of Four-Factor Prothrombin Complex Concentrate With Andexanet alfa for Reversal of Nontraumatic Intracranial Hemorrhage"],"prefix":"10.1177","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3451-1987","authenticated-orcid":false,"given":"Sophia","family":"Pathan","sequence":"first","affiliation":[{"name":"Hospital of the University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.07.040"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2015.11.026"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.013343"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-015-0222-x"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2727"},{"key":"e_1_3_2_7_2","unstructured":"Kcentra (prothrombin complex concentrate [human]). Package insert. CSL Behring LLC; 2018."},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12959-017-0129-1"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.029017"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/nm.3102"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1586\/17474086.2016.1135046"},{"key":"e_1_3_2_12_2","unstructured":"Andexxa (coagulation factor Xa [recombinant] inactivated-zhzo). Package insert. Portola Pharmaceuticals Inc.; 2018."},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814051"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.04.053"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25475"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018024893"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14838"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2019.09.001"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987319849763"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-05-782060"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1675417"},{"key":"e_1_3_2_22_2","unstructured":"ClinicalTrials.gov [Internet]. Identifier NCT03661528 Trial of Andexanet in ICH Patients Receiving an Oral FXa Inhibitor. National Library of Medicine (US); September 7 2018.\u2009Accessed June 22 2022.\u2009https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03661528"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2020.106070"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15031"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000356"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2019.12.026"},{"issue":"1","key":"e_1_3_2_27_2","first-page":"1","article-title":"Real-life applications and challenges of andexanet alfa for life-threatening bleeding and reversal prior to surgery","volume":"5","author":"Modi K","year":"2021","unstructured":"Modi K, Attar D, Rimsans J, et al. Real-life applications and challenges of andexanet alfa for life-threatening bleeding and reversal prior to surgery. Thromb Haemost Res. 2021;5(1):1-5.","journal-title":"Thromb Haemost Res"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/1076029619896619"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxac079"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-022-02658-w"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1607887"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rpth.2023.100107"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.26355\/eurrev_202103_25428"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.04.061"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018024133"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40560-018-0303-y"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1510991"}],"container-title":["Hospital Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00185787241229192","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00185787241229192","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00185787241229192","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:03:19Z","timestamp":1784545399000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00185787241229192"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,16]]},"references-count":36,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1177\/00185787241229192"],"URL":"https:\/\/doi.org\/10.1177\/00185787241229192","relation":{},"ISSN":["0018-5787","1945-1253"],"issn-type":[{"value":"0018-5787","type":"print"},{"value":"1945-1253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,16]]}}}