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The following is a summary of “Reversal of Factor Xa Inhibitor-Related Intracranial Hemorrhage: A Multicenter, Retrospective, Observational Study Comparing the Efficacy and Safety of Andexanet and Prothrombin Complex Concentrates,” published in the April 2025 issue of Critical Care Medicine by Panos et al. 

Researchers conducted a retrospective study to assess the efficacy and safety of andexanet and prothrombin complex concentrates (PCCs) in managing intracranial hemorrhage (ICrH) associated with apixaban or rivaroxaban.  

They analyzed data from 1,133 individuals with ICrH related to apixaban or rivaroxaban who received andexanet or PCCs between January 1, 2015, and March 31, 2023. A predefined sensitivity analysis excluded individuals with an admission Glasgow Coma Scale score below 7. The study was carried out across 42 stroke centers in the United States.  

The results showed that among 1,133 individuals evaluated, 1,096 were included in the analysis. In the full hemostatic efficacy assessment, andexanet (87.8%) was associated with greater odds of achieving excellent or good hemostasis (odds ratio [OR] 1.60; 95% CI, 1.00–2.56; P = 0.048) compared to PCCs (81.8%). The occurrence of thrombotic events (TE) was higher with andexanet (7.9%) than with PCCs (4.2%) (OR 1.91; 95% CI, 1.13–3.20; P = 0.014). The sensitivity analysis did not reveal differences in hemostatic or thrombotic outcomes.  

Investigators concluded that while andexanet showed higher hemostatic efficacy, it also correlated with increased TES, and when severe neurologic injuries were excluded, treatment outcomes were comparable. 

Source: journals.lww.com/ccmjournal/abstract/9900/reversal_of_factor_xa_inhibitor_related.507.aspx