What medication starting with X is used to treat excessive bleeding, also known as hemorrhage?

From the Guidelines

Xanexa is not a suitable option, however, a medication that can be used to treat excessive bleeding is Andexanet alfa, a recombinant truncated human factor Xa variant, which can reverse the effects of factor Xa inhibitors. Andexanet alfa works by competitively binding to direct factor Xa inhibitors or to indirect factor Xa inhibitor-activated antithrombin, thereby reversing their anticoagulant effects 1. This medication is particularly useful in cases of severe and life-threatening bleeding, which includes bleeding causing hemodynamic compromise, intracranial hemorrhage, bleeding into a critical organ or closed space, persistent bleeding despite general supportive measures and local hemostatic support, or risk of recurrent bleeding due to excess NOAC drug exposure 1.

Key Points

• Andexanet alfa is administered as a 400-800 mg IV bolus, followed by an infusion of 4-8 mg/min, with the dose depending on the specific factor Xa inhibitor being reversed and the severity of the bleeding 1.
• The onset of action is approximately 2 minutes, with a terminal half-life of around 6 hours 1.
• Andexanet alfa has been shown to effectively reverse the anticoagulant effects of direct and indirect factor Xa inhibitors, including apixaban and rivaroxaban 1.
• It is essential to note that Andexanet alfa should be used sparingly in cases of severe and life-threatening bleeding, as general hemostatic agents are less effective in reversing coagulation abnormalities and may be potentially prothrombotic 1.

Administration and Monitoring

• Andexanet alfa should be administered immediately in patients with life-threatening bleeding presumed to be on an NOAC, without waiting for laboratory confirmation of therapeutic levels of anticoagulation 1.
• Coagulation testing can help identify patients who will likely benefit from specific reversal agents and monitor the response to reversal, but it should not delay the administration of Andexanet alfa in emergency situations 1.

From the FDA Drug Label

Tranexamic acid injection is an antifibrinolytic indicated in patients with hemophilia for short-term use (2 to 8 days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction

The medication starting with the letter that is closest to X is Tranexamic acid, which is used to treat excessive bleeding, also known as hemorrhage, in patients with hemophilia. 2

From the Research

Medication for Excessive Bleeding

• The medication starting with the letter X used to treat excessive bleeding, also known as hemorrhage, is not explicitly mentioned in the provided studies.
• However, a medication that is commonly used to treat excessive bleeding is Tranexamic acid (TXA) 3, 4, 5, 6, 7.

Uses of Tranexamic Acid

• Tranexamic acid is used to treat various types of bleeding, including:
  • Postpartum hemorrhage 3, 5, 6, 7
  • Menorrhagia (heavy menstrual bleeding) 3, 4, 6
  • Trauma-associated hemorrhage 3, 5, 6, 7
  • Surgical bleeding 3, 6
  • Gastrointestinal bleeding 5, 6, 7

Efficacy and Safety of Tranexamic Acid

• Tranexamic acid has been shown to be effective in reducing bleeding and improving clinical outcomes in various clinical settings 3, 4, 5, 6, 7.
• The safety profile of tranexamic acid is generally considered to be good, with a low risk of thrombotic events 4, 5, 6, 7.