Neuroanesthesia & neurocritical care
Reversal of Factor Xa Inhibitor-Related Intracranial Hemorrhage: A Multicenter, Retrospective, Observational Study Comparing the Efficacy and Safety of Andexanet and Prothrombin Complex Concentrates
Main finding · Excellent or good hemostasisResult — go to the resultOdds ratio 1.60 95% CI 1.00–2.56Authors' conclusion
Despite statistically higher odds of achieving hemostatic efficacy with andexanet, we also observed higher odds of a TE with no difference in discharge outcomes observed between groups.
Study context
- Population
- Patients with apixaban or rivaroxaban-related intracranial hemorrhage, 42 US stroke centers, 2015–20231,096 included
- Participants
- 1,133 patients
- Exposure
- Andexanet vs prothrombin complex concentrates (PCCs)
- Outcome
- Excellent or good hemostasis (modified Sarode criteria); primary safety outcome thrombotic event during hospital stay
Methodological detailsmulticentre, observational, predefined sensitivity analysis
- Multicentre
- Observational
- Predefined sensitivity analysis
Main finding
Excellent or good hemostasis
Odds ratio
1.60
95% CI 1.00–2.56
P = 0.048
By group
Andexanet vs PCCs
OR 1.60 (95% CI 1.00–2.56); P = 0.048
As reported in the abstract
Observational data: associations, not effects.
Further findings
Hemostatic and thrombotic outcomes, sensitivity analysis excluding GCS <7
- No differences in hemostatic or thrombotic outcomes
Safety
| Outcome | Andexanet | PCCs | OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Thrombotic event during hospital stay (primary safety outcome) | 7.9% | 4.2% | 1.91 (1.13–3.20) | P = 0.014 | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Reversal of Factor Xa Inhibitor-Related Intracranial Hemorrhage: A Multicenter, Retrospective, Observational Study Comparing the Efficacy and Safety of Andexanet and Prothrombin Complex Concentrates. Crit Care Med. Published 1 April 2025. doi:10.
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