Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage

In this episode, we break down the ANNEXA-I randomized trial, which looked at patients with factor Xa inhibitor-associated intracerebral hemorrhage. The study compared andexanet alfa, a targeted reversal agent, with usual care (mainly prothrombin complex concentrate).

The results? Andexanet showed better hemostatic control and more effectively reduced hematoma expansion (67% vs. 53.1%), with a 94.5% median drop in anti-factor Xa activity. But the benefit came with a trade-off—higher rates of thrombotic events, particularly ischemic stroke.

We dive into the clinical implications of these findings and what they mean for balancing bleeding control with thrombotic risk. Whether you're managing ICH cases or staying updated on anticoagulation reversal strategies, this one’s for you.