Real-world andexanet alfa utilization and the association between delay in administration due to hospital transfer and all-cause inpatient mortality

Abstract

Background

Evaluations of andexanet alfa for the reversal of factor Xa inhibitor-associated bleeding have been small, with cohorts drawn from single/limited sites. Delays in providing anticoagulation reversal due to hospital transfer may result in poorer outcomes.

Objectives

To describe the characteristics and outcomes of andexanet alfa users and evaluate the association between delay in andexanet alfa administration due to transfer from a different acute care hospital and the incidence of all-cause inpatient mortality.

Methods

This was a retrospective study using National Inpatient Sample data. Hospitalizations with procedural codes for andexanet alfa and a billing code for bleeding were included. Descriptive analysis was performed, as was multivariable logistic regression, to estimate the odds ratio and 95% CI for the association between andexanet alfa delayed due to transfer from a different acute care hospital and all-cause inpatient mortality.

Results

From 2019 to 2021, 4210 hospitalizations occurred in adults receiving andexanet alfa and a bleed. Most were hospitalized with intracranial hemorrhage (62.0%). The incidence of all-cause inpatient mortality was 16.6% (95% CI, 14.3%-19.3%), mean hospital stays lasted 9.1 days (95% CI, 8.4-9.8), and mean hospital costs were $73,600 (95% CI, $65,000-$82,200). Of all cases, 18.5% were transferred from a different acute care hospital prior to receiving andexanet alfa. Cases with hospital transfer had an 82% increased odds of all-cause inpatient mortality (95% CI, 17%-183%) but did not reach statistical significance when the population was limited to intracranial hemorrhage (odds ratio, 1.51; 95% CI, 0.88-2.60).

Conclusion

Delay in administering andexanet alfa due to hospital transfer may be associated with increased all-cause mortality.