The following is a summary of “Use of andexanet alfa and 4-factor prothrombin complex concentrate in intracranial hemorrhage,” published in the February 2023 issue of Emergency Medicine by Oh, et al.

For a study, researchers sought to present the clinical and safety results for the reversal of apixaban or rivaroxaban in the presence of an intracranial hemorrhage (ICH) using andexanet alfa (AA) and 4-factor prothrombin complex concentrate (4F-PCC).

From June 2018 to October 2019, hospitalized patients aged 18 or older who received AA or 4F-PCC for the reversal of apixaban or rivaroxaban in the context of ICH were the subjects of a retrospective, multicentered descriptive research. Patients were disqualified if they got 4F-PCC after it was added to the institution’s extensive formulary before receiving AA. Other exclusion criteria included having a history of or being diagnosed with disseminated intravascular coagulation, heparin-induced thrombocytopenia, an estimated hematoma volume of >60 mL, a Glasgow Coma Score <7, or not having a repeat CT head scan. From the computerized medical records, data was gathered. The main result was achieving excellent or good hemostatic effectiveness on the follow-up computer tomography (CT) scan following the study medication infusion. In addition to disposition, secondary outcomes included length of hospital stay, length of ICU stay, the incidence of thromboembolic events, survival to hospital release, 30-day readmission, and disposition.

About 24 patients, 9 of whom got AA and 15 received 4F-PCC, were involved in the research. When given a second CT scan, 7 (77.8%) patients in the AA group and 14 (93.3%) patients in the 4-F PCC group both had excellent or good hemostatic effectiveness. 86.7% of patients in the 4F-PCC group and all patients in the AA group made it to hospital discharge without experiencing any 30-day morality.

The study demonstrates that andexanet alfa and 4F-PCC had similar real-world clinical and safety results to those shown in clinical trials for the reversal of factor Xa inhibitors in the presence of ICH.

Reference: sciencedirect.com/science/article/pii/S0735675722007288