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The use of andexanet alfa and 4-factor prothrombin complex concentrate in intracranial hemorrhage.
Oh, Elly S; Schulze, Paul; Diaz, Frank; Shah, Kunal; Rios, Jose; Silverman, Michael E.
Afiliação
  • Oh ES; Department of Pharmacy, Morristown Medical Center, 100 Madison Ave, Morristown, NJ 07960, United States of America. Electronic address: ellyoh119@gmail.com.
  • Schulze P; Department of Radiology, Morristown Medical Center, 100 Madison Ave, Morristown, NJ 07960, United States of America. Electronic address: paul.schulze@atlantichealth.org.
  • Diaz F; Department of Pharmacy, Morristown Medical Center, 100 Madison Ave, Morristown, NJ 07960, United States of America. Electronic address: frank.diaz@atlantichealth.org.
  • Shah K; Department of Pharmacy, Morristown Medical Center, 100 Madison Ave, Morristown, NJ 07960, United States of America. Electronic address: kunal.shah@atlantichealth.org.
  • Rios J; Department of Radiology, Morristown Medical Center, 100 Madison Ave, Morristown, NJ 07960, United States of America. Electronic address: jose.rios@atlantichealth.org.
  • Silverman ME; Department of Emergency Medicine, Morristown Medical Center, 100 Madison Ave, Morristown, NJ 07960, United States of America. Electronic address: michael.silverman@atlantichealth.org.
Am J Emerg Med ; 64: 74-77, 2023 02.
Article em En | MEDLINE | ID: mdl-36463661
ABSTRACT

OBJECTIVE:

to describe the clinical and safety outcomes between andexanet alfa (AA) and 4-factor prothrombin complex concentrate (4F-PCC) for the reversal of apixaban or rivaroxaban in the setting of an intracranial hemorrhage (ICH).

METHODS:

A retrospective, multicentered descriptive study was conducted in hospitalized patients 18 years of age or older from June 2018 to October 2019 who received AA or 4F-PCC for the reversal of apixaban or rivaroxaban in the setting of ICH. Patients were excluded if they had received 4F-PCC prior to AA after its addition to the institution wide formulary. Other exclusion criteria were history or presence of heparin-induced thrombocytopenia or disseminated intravascular coagulation, estimated hematoma volume of >60 mL, Glasgow Coma Scores <7, or no repeat CT head scan. Information was collected from the electronic medical records. The primary outcome was the achievement of excellent or good hemostatic efficacy upon the repeat computer tomography (CT) scan performed after the infusion of study drugs. Secondary outcomes included disposition, survival to hospital discharge, 30-day readmission, length of hospital stay, length of ICU stay, incidence of thromboembolic events.

RESULTS:

A total of 24 patients were included in the study, of which 9 received AA and 15 received 4F-PCC. The achievement of excellent or good hemostatic efficacy upon repeat CT scan occurred in 7 (77.8%) patients in the AA group and in 14 (93.3%) patients in the 4-F PCC group. All patients in the AA group survived to hospital discharge with no 30-day morality and 86.7% patients in the 4F-PCC group.

CONCLUSION:

This study suggests that real-world clinical and safety outcomes between andexanet alfa and 4F-PCC for the reversal of factor Xa inhibitors in the setting of ICH are similar to ones reported in clinical trials.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Hemostáticos / Rivaroxabana Limite: Adolescent / Adult / Humans Idioma: En Revista: Am J Emerg Med Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Hemostáticos / Rivaroxabana Limite: Adolescent / Adult / Humans Idioma: En Revista: Am J Emerg Med Ano de publicação: 2023 Tipo de documento: Article