rivaroxaban + andexanet alfa

**Rivaroxaban + andexanet alfa** is a combination regimen where rivaroxaban, a direct oral anticoagulant (DOAC) and factor Xa inhibitor, is used for the prevention and treatment of thromboembolic disorders, and andexanet alfa is administered as a specific reversal agent to counteract rivaroxaban's anticoagulant effects in cases of life-threatening or uncontrolled bleeding. Rivaroxaban inhibits both free and bound factor Xa, thereby preventing thrombin generation and clot formation. Andexanet alfa is a recombinant, catalytically inactive form of human factor Xa that acts as a high-affinity "decoy", binding and sequestering factor Xa inhibitors such as rivaroxaban, rapidly reversing anticoagulation and restoring normal thrombin generation. In addition, andexanet alfa may bind and inhibit tissue factor pathway inhibitor, transiently increasing tissue factor-initiated thrombin generation[1][2][3][4][5].