{"pk":18028,"title":"Treatment of Factor-Xa Inhibitor-associated Bleeding with Andexanet Alfa or 4 Factor PCC: A Multicenter Feasibility Retrospective Study","subtitle":null,"abstract":"Background:\n There are no randomized trials comparing andexanet alfa and 4 factor prothrombin complex concentrate (4F-PCC) for the treatment of factor Xa inhibitor (FXa-I)-associated bleeds, and observational studies lack important patient characteristics. We pursued this study to demonstrate the feasibility of acquiring relevant patient characteristics from electronic health records. Secondarily, we explored outcomes in patients with life-threatening FXa-I associated bleeds after adjusting forthese variables.\nMethods:\n We conducted a multicenter, chart review of 100 consecutive adult patients with FXa-I associated intracerebral hemorrhage (50) or gastrointestinal bleeding (50) treated with andexanet alfa or 4F-PCC. We collected demographic, clinical, laboratory, and imaging data including time from last factor FXa-I dose and bleed onset.\nResults: \nMean (SD) age was 75 (12) years; 34% were female. Estimated time from last FXa-I dose to bleed onset was present in most cases (76%), and patients treated with andexanet alfa and 4F-PCC were similar in baseline characteristics. Hemostatic efficacy was excellent/good in 88% and 76% of patients treated with andexanet alfa and 4F-PCC, respectively (P = 0.29). Rates of thrombotic events within 90 days were 14% and 16% in andexanet alfa and 4F-PCC patients, respectively (P = 0.80). Survival to hospital discharge was 92% and 76% in andexanet alfa and 4F-PCC patients, respectively (P = 0.25). Inclusion of an exploratory propensity score and treatment in a logistic regression model resulted in an odds ratio in favor of andexanet alfa of 2.01 (95% confidence interval 0.67–6.06) for excellent/good hemostatic efficacy, although the difference was not statistically significant.\nConclusion: \nImportant patient characteristics are often documented supporting the feasibility of a large observational study comparing real-life outcomes in patients with FXa-I-associated bleeds treated with andexanet alfa or 4F-PCC. The small sample size in the current study precluded definitive conclusions regarding the safety and efficacy of andexanet alfa or 4F-PCC in FXa-I-associated bleeds.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"intracerebral hemorrhage, gastrointestinal bleeding, anticoagulation, reversal, Factor Xa inhibitors"}],"section":"Neurology","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5hf50287","frozenauthors":[{"first_name":"Adam","middle_name":"J.","last_name":"Singer","name_suffix":"","institution":"Renaissance School of Medicine at Stony Brook University, Department of Emergency Medicine, Stony Brook, New York","department":"None"},{"first_name":"Mauricio","middle_name":"","last_name":"Concha","name_suffix":"","institution":"Sarasota Memorial Hospital, Department of Neuroscience, Sarasota, Florida","department":"None"},{"first_name":"James","middle_name":"","last_name":"Williams","name_suffix":"","institution":"Meritus Health, Department of Emergency Medicine, Hagerstown, Maryland","department":"None"},{"first_name":"Caitlin","middle_name":"S.","last_name":"Brown","name_suffix":"","institution":"Mayo Clinic-Rochester, Department of Pharmacy, Rochester, Minnesota","department":"None"},{"first_name":"Rafael","middle_name":"","last_name":"Fernandes","name_suffix":"","institution":"Renaissance School of Medicine at Stony Brook University, Department of Emergency Medicine, Stony Brook, New York","department":"None"},{"first_name":"Henry","middle_name":"C.","last_name":"Thode","name_suffix":"","institution":"Renaissance School of Medicine at Stony Brook University, Department of Emergency Medicine, Stony Brook, New York","department":"None"},{"first_name":"Marylin","middle_name":"","last_name":"Kirchman","name_suffix":"","institution":"Sarasota Memorial Hospital, Department of Neuroscience, Sarasota, Florida","department":"None"},{"first_name":"Alejandro","middle_name":"A.","last_name":"Rabinstein","name_suffix":"","institution":"Mayo Clinic-Rochester, Department of Neurosurgery, Rochester, Minnesota","department":"None"}],"date_submitted":"2023-03-31T18:00:17Z","date_accepted":"2023-03-31T18:00:17Z","date_published":"2023-08-22T17:31:18Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18028/galley/9196/download/"}]}