Andexanet Alfa Reduces Hematoma Expansion in Intracerebral Hemorrhage Patients Receiving Factor Xa Inhibitors: NEJM

The key findings of the study were as follows:

• A total of 530 patients with acute intracerebral hemorrhage and recent use of factor Xa inhibitors were enrolled in the study, with 263 assigned to receive andexanet and 267 to receive usual care.

• Hemostatic efficacy, defined by limited hematoma volume expansion, was achieved in 67.0% of patients receiving andexanet alfa, compared to 53.1% of patients receiving usual care.

• No significant differences were observed between the groups in terms of functional outcomes or mortality within 30 days.

• Thrombotic events occurred in 10.3% of patients receiving andexanet and 5.6% receiving usual care, with ischemic stroke occurring in 6.5% and 1.5% of patients, respectively.

The study demonstrates that andexanet alfa improves control of hematoma expansion in patients with intracerebral hemorrhage who are receiving factor Xa inhibitors. However, its use is associated with an increased risk of thrombotic events, including ischemic stroke.

Andexanet alfa shows promise in reducing hematoma expansion in patients with intracerebral hemorrhage on factor Xa inhibitors, but its use must be carefully balanced with the risk of thrombotic events. Further research is needed to optimize its safety and efficacy profile in this population.

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