2022
DOI: 10.1186/s13054-022-04043-8
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Andexanet alfa versus four-factor prothrombin complex concentrate for the reversal of apixaban- or rivaroxaban-associated intracranial hemorrhage: a propensity score-overlap weighted analysis

Abstract: Background Andexanet alfa is approved (FDA “accelerated approval”; EMA “conditional approval”) as the first specific reversal agent for factor Xa (FXa) inhibitor-associated uncontrolled or life-threatening bleeding. Four-factor prothrombin complex concentrates (4F-PCC) are commonly used as an off-label, non-specific, factor replacement approach to manage FXa inhibitor-associated life-threatening bleeding. We evaluated the effectiveness and safety of andexanet alfa versus 4F-PCC for management o… Show more

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Cited by 43 publications
(41 citation statements)
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“…To date, the only FDA‐approved indication for PCC is reversal of vitamin K antagonists in acute major bleeding 8 . In a propensity score‐weighted analysis of two cohorts who received andexanet or PCC for reversal of apixaban or rivaroxaban in intracranial hemorrhage, andexanet was associated with greater hemostasis and reduced mortality compared to PCC 9 …”
Section: Discussionmentioning
confidence: 99%
“…To date, the only FDA‐approved indication for PCC is reversal of vitamin K antagonists in acute major bleeding 8 . In a propensity score‐weighted analysis of two cohorts who received andexanet or PCC for reversal of apixaban or rivaroxaban in intracranial hemorrhage, andexanet was associated with greater hemostasis and reduced mortality compared to PCC 9 …”
Section: Discussionmentioning
confidence: 99%
“…Indirect comparisons and observational data suggest better outcomes from using specific antidotes. 58 59 These hypothesis-generating observations are currently being tested in the ANNEXA-I study—a randomized trial in DOAC-related ICH which compares andexanet alfa directly against standard of care including PCC.…”
Section: Challenges For the Emergency Teammentioning
confidence: 99%
“…However, when andexanet alfa is available, this should be preferred to the use of PCC for treatment of patients with major bleeding on oral direct FXa inhibitors. 19 , 20 …”
Section: Management Of Bleeding Patientmentioning
confidence: 99%