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

## TL;DR

This study found that delays in administering andexanet alfa due to hospital transfers may be linked to higher inpatient mortality rates.

## Contribution

The study provides real-world data on andexanet alfa use and highlights the potential impact of hospital transfer delays on patient outcomes.

## Key findings

- Hospital transfers before andexanet alfa administration occurred in 18.5% of cases.
- Transfers were associated with an 82% increased odds of inpatient mortality, though not statistically significant for intracranial hemorrhage cases.

## Abstract

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.

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.

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.

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).

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

•Delaying anticoagulation reversal due to hospital transfer may result in poorer outcomes.•This was a retrospective study using National Inpatient Sample data from 2019 to 2021.•Of 4210 cases, 18.5% were transferred from a different hospital prior to andexanet alfa use.•Hospital transfer was associated with an 82% (95% CI, 17%-183%) increased odds of inpatient death.

Delaying anticoagulation reversal due to hospital transfer may result in poorer outcomes.

This was a retrospective study using National Inpatient Sample data from 2019 to 2021.

Of 4210 cases, 18.5% were transferred from a different hospital prior to andexanet alfa use.

Hospital transfer was associated with an 82% (95% CI, 17%-183%) increased odds of inpatient death.