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

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.