Trends and variation in the use of andexanet alfa for the reversal of direct oral anticoagulants in NHS trusts in England

Louis Fisher; Richard Buka; Rosalind Byrne; Stephen Black; Helen J. Curtis; Christopher Wood; Andrew Brown; Sebastian Bacon; Richard Croker; Ben Goldacre; Brian MacKenna; Victoria Speed

doi:10.1002/bcp.70417

Trends and variation in the use of andexanet alfa for the reversal of direct oral anticoagulants in NHS trusts in England

Louis Fisher^*
, Richard Buka
, Rosalind Byrne
, Stephen Black
, Helen J. Curtis
, Christopher Wood
, Andrew Brown
, Sebastian Bacon
, Richard Croker
, Ben Goldacre
, Brian MacKenna
, Victoria Speed^*

^*Corresponding author for this work

Cardiovascular Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Aims: Andexanet alfa was recommended by the National Institute for Health and Clinical Excellence (NICE) as an option in the management of life‐threatening gastrointestinal bleeding in patients taking apixaban or rivaroxaban in May 2021. A recent UK‐wide survey of local hospital protocols for the use of andexanet alfa suggested that practice across the United Kingdom is highly variable. In January 2025, NICE was unable to make a recommendation on the use of andexanet alfa for reversing anticoagulation in adults with intracranial haemorrhage. We set out to report trends and variation in the uptake of andexanet alfa across the NHS in England, using the new OpenPrescribing Hospitals platform.

Methods: To assess the uptake of andexanet alfa, we analysed pharmacy stock control data from NHS trusts in England using the openly available Secondary Care Medicines Dataset. Analysis was restricted to NHS trusts with 24‐h consultant‐led emergency care activity.

Results: Between May 2021 and June 2025, 19 608 vials of andexanet alfa were issued in NHS trusts in England. There was wide variation in the timing and speed of uptake across NHS trusts. Substantial variation was also observed between NHS Regions in England.

Conclusions: The use of andexanet alfa varies markedly between NHS regions and between NHS trusts in England. This study is the first analysis of adoption of a new treatment using the OpenPrescribing Hospitals platform, which is expected to provide a generalizable framework for similar analyses in the future.

Original language	English
Number of pages	7
Journal	British Journal of Clinical Pharmacology
Early online date	17 Dec 2025
DOIs	https://doi.org/10.1002/bcp.70417
Publication status	E-pub ahead of print - 17 Dec 2025

Keywords

anticoagulants
thrombosis
anticoagulant reversal agents
antidotes

Access to Document

10.1002/bcp.70417Licence: Creative Commons: Attribution (CC BY)

FisherL2025TrendsFinal published version, 1.94 MBLicence: Creative Commons: Attribution (CC BY)

Cite this

Fisher, L., Buka, R., Byrne, R., Black, S., Curtis, H. J., Wood, C., Brown, A., Bacon, S., Croker, R., Goldacre, B., MacKenna, B., & Speed, V. (2025). Trends and variation in the use of andexanet alfa for the reversal of direct oral anticoagulants in NHS trusts in England. British Journal of Clinical Pharmacology. Advance online publication. https://doi.org/10.1002/bcp.70417

@article{e40f6f46f7404d33ab870daa80f42f6d,

title = "Trends and variation in the use of andexanet alfa for the reversal of direct oral anticoagulants in NHS trusts in England",

abstract = "Aims: Andexanet alfa was recommended by the National Institute for Health and Clinical Excellence (NICE) as an option in the management of life‐threatening gastrointestinal bleeding in patients taking apixaban or rivaroxaban in May 2021. A recent UK‐wide survey of local hospital protocols for the use of andexanet alfa suggested that practice across the United Kingdom is highly variable. In January 2025, NICE was unable to make a recommendation on the use of andexanet alfa for reversing anticoagulation in adults with intracranial haemorrhage. We set out to report trends and variation in the uptake of andexanet alfa across the NHS in England, using the new OpenPrescribing Hospitals platform. Methods: To assess the uptake of andexanet alfa, we analysed pharmacy stock control data from NHS trusts in England using the openly available Secondary Care Medicines Dataset. Analysis was restricted to NHS trusts with 24‐h consultant‐led emergency care activity. Results: Between May 2021 and June 2025, 19 608 vials of andexanet alfa were issued in NHS trusts in England. There was wide variation in the timing and speed of uptake across NHS trusts. Substantial variation was also observed between NHS Regions in England. Conclusions: The use of andexanet alfa varies markedly between NHS regions and between NHS trusts in England. This study is the first analysis of adoption of a new treatment using the OpenPrescribing Hospitals platform, which is expected to provide a generalizable framework for similar analyses in the future.",

keywords = "anticoagulants, thrombosis, anticoagulant reversal agents, antidotes",

author = "Louis Fisher and Richard Buka and Rosalind Byrne and Stephen Black and Curtis, \{Helen J.\} and Christopher Wood and Andrew Brown and Sebastian Bacon and Richard Croker and Ben Goldacre and Brian MacKenna and Victoria Speed",

year = "2025",

month = dec,

day = "17",

doi = "10.1002/bcp.70417",

language = "English",

journal = "British Journal of Clinical Pharmacology",

issn = "0306-5251",

publisher = "Wiley",

}

TY - JOUR

T1 - Trends and variation in the use of andexanet alfa for the reversal of direct oral anticoagulants in NHS trusts in England

AU - Fisher, Louis

AU - Buka, Richard

AU - Byrne, Rosalind

AU - Black, Stephen

AU - Curtis, Helen J.

AU - Wood, Christopher

AU - Brown, Andrew

AU - Bacon, Sebastian

AU - Croker, Richard

AU - Goldacre, Ben

AU - MacKenna, Brian

AU - Speed, Victoria

PY - 2025/12/17

Y1 - 2025/12/17

N2 - Aims: Andexanet alfa was recommended by the National Institute for Health and Clinical Excellence (NICE) as an option in the management of life‐threatening gastrointestinal bleeding in patients taking apixaban or rivaroxaban in May 2021. A recent UK‐wide survey of local hospital protocols for the use of andexanet alfa suggested that practice across the United Kingdom is highly variable. In January 2025, NICE was unable to make a recommendation on the use of andexanet alfa for reversing anticoagulation in adults with intracranial haemorrhage. We set out to report trends and variation in the uptake of andexanet alfa across the NHS in England, using the new OpenPrescribing Hospitals platform. Methods: To assess the uptake of andexanet alfa, we analysed pharmacy stock control data from NHS trusts in England using the openly available Secondary Care Medicines Dataset. Analysis was restricted to NHS trusts with 24‐h consultant‐led emergency care activity. Results: Between May 2021 and June 2025, 19 608 vials of andexanet alfa were issued in NHS trusts in England. There was wide variation in the timing and speed of uptake across NHS trusts. Substantial variation was also observed between NHS Regions in England. Conclusions: The use of andexanet alfa varies markedly between NHS regions and between NHS trusts in England. This study is the first analysis of adoption of a new treatment using the OpenPrescribing Hospitals platform, which is expected to provide a generalizable framework for similar analyses in the future.

AB - Aims: Andexanet alfa was recommended by the National Institute for Health and Clinical Excellence (NICE) as an option in the management of life‐threatening gastrointestinal bleeding in patients taking apixaban or rivaroxaban in May 2021. A recent UK‐wide survey of local hospital protocols for the use of andexanet alfa suggested that practice across the United Kingdom is highly variable. In January 2025, NICE was unable to make a recommendation on the use of andexanet alfa for reversing anticoagulation in adults with intracranial haemorrhage. We set out to report trends and variation in the uptake of andexanet alfa across the NHS in England, using the new OpenPrescribing Hospitals platform. Methods: To assess the uptake of andexanet alfa, we analysed pharmacy stock control data from NHS trusts in England using the openly available Secondary Care Medicines Dataset. Analysis was restricted to NHS trusts with 24‐h consultant‐led emergency care activity. Results: Between May 2021 and June 2025, 19 608 vials of andexanet alfa were issued in NHS trusts in England. There was wide variation in the timing and speed of uptake across NHS trusts. Substantial variation was also observed between NHS Regions in England. Conclusions: The use of andexanet alfa varies markedly between NHS regions and between NHS trusts in England. This study is the first analysis of adoption of a new treatment using the OpenPrescribing Hospitals platform, which is expected to provide a generalizable framework for similar analyses in the future.

KW - anticoagulants

KW - thrombosis

KW - anticoagulant reversal agents

KW - antidotes

U2 - 10.1002/bcp.70417

DO - 10.1002/bcp.70417

M3 - Article

SN - 0306-5251

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

ER -

Trends and variation in the use of andexanet alfa for the reversal of direct oral anticoagulants in NHS trusts in England

Abstract

Keywords

Access to Document

Fingerprint

Cite this