PB0988 - Assessing andexanet alfa Prescribing and Administration Practices: A Single Institution Study to Improve Patient Safety

Background: Andexanet alfa (AA) is FDA approved to treat life-threatening or uncontrolled bleeding from anti-Xa inhibitors. Given the significant cost and high-risk nature of AA, it should be used judiciously for it’s approved indication, be ordered with the correct dose, and be timely administered for maximum benefit. To our knowledge, this project is the first quality improvement study to report on ordering and administration practices of AA.

Aims: This study aims to provide a granular review of AA prescribing practices at a single institution and to provide recommendations to improve patient safety.

Methods: This retrospective study reviewed all adult patients treated with AA at a single institution between January 1, 2018, and March 31, 2020. We identified ordering and administration benchmarks based on recommendations from the ANEXXA-4 trial. We then collected data to determine compliance with these benchmarks and to assess adverse events.

Results: Twenty-two AA dosing sets (loading and infusion dose) were given to 20 patients. Eight (36%) dosing sets met our ordering benchmarks regarding appropriate dose, time since last DOAC, urgency of administration and documentation. Two (9%) dosing sets met the administrative benchmarks of being started within 30 minutes of the initial order and 13 (59%) dosing sets had timely infusion of the infusion dose after the loading dose. There were two thrombotic complications within 72 hours of the correct AA dose and one death suspected to be from AA.

Conclusion(s): This study highlights challenges in ordering and administering AA and also provides recommendations for optimized order sets, a streamlined administration process, and frequent provider education. These recommendations are practical and measurable, and can be implemented at any institution to potentially improve patient safety.