A medical expert discusses the findings of a randomized trial investigating the use of andexanet alfa versus usual care in patients with acute intracerebral hemorrhage (ICH) and recent direct oral anticoagulant (DOAC) use.
At the 2023 World Stroke Congress recap, a medical expert highlighted a randomized trial comparing rapid andexanet administration to standard care for acute intracerebral hemorrhage linked to recent factor Xa inhibitor intake. Eligible patients, averaging 79 years old with multiple cardiovascular risks, underwent baseline CT scans within six hours of symptom onset. They had to be randomized within two hours and treated soon after. The study measured hemostatic efficacy based on hematoma expansion and NIHSS score changes. The trial, encompassing 530 patients from 20+ countries, revealed significant improvements in controlling hematoma expansion and reducing Factor Xa inhibitor levels with andexanet alfa treatment. However, andexanet alfa use correlated with a 10% increase in thrombotic events compared to the 5% rate in the standard care arm, notably affecting ischemic stroke occurrence in the andexanet alfa group. These findings suggest both benefits and risks associated with andexanet alfa usage in acute intracerebral hemorrhage, emphasizing its impact on controlling hematoma size but also highlighting an increased risk of thrombotic events. The trial's breadth and statistical robustness underscored the significance of these outcomes within the elderly population with multiple cardiovascular comorbidities, outlining the complexity and considerations in acute stroke management associated with anticoagulant reversal agents like andexanet alfa.
Video synopsis is AI-generated and reviewed by AJMC editorial staff.