Andexanet alfa (Ondexxya) currently holds UK marketing authorisation (MA) for adult patients treated with a direct factor Xa (FXa) inhibitor (apixaban or rivaroxaban) when reversal of anticoagulation is indicated for life-threatening or uncontrolled bleeding.¹ In National Health Service (NHS) Scotland, andexanet alfa is reimbursed for bleeding at any site,² while in the rest of the United Kingdom, the National Institute of Health and Care Excellence (NICE) made recommendation in 2021 for its use in gastrointestinal bleeding only.³ The summary of product characteristics states that serious arterial and venous thromboembolic events have been reported following treatment with andexanet alfa, including reports of early manifestation (within 72 h) after administration.¹