Pro/Con Debate: Flip It and Reverse It: ICH Management

Tuesday, January 23, 2024

1:30 PM – 2:15 PM MT

Location: West-301BC

CE: 0.75

Concurrent Session Moderator(s)

Caitlin Brown, BCCCP, PharmD, FCCM (she/her/hers)

Neurocritical Care & Emergency Medicine Pharmacist
Mayo Clinic
Rochester, Minnesota

Having an intracranial hemorrhage (ICH) while anticoagulated has high morbidity and mortality. The 2022 ICH guidelines provide recommendations for acute reversal of anticoagulation for factor Xa inhibitors, including use of 4-factor prothrombin complex concentrate and andexanet alfa. Comparative clinical trial data is expected to be published in 2023 or 2024 from the ANNEXA-I trial. The cost of andexanet alfa has previously been prohibitive, but recent changes have led institutions to reevaluate its role in ICH therapy for ICH management.

Learning Objectives:

Discuss acute reversal of factor Xa inhibitors after intracranial hemorrhage (ICH), highlighting the use of prothrombin complex concentrates (PCCs) and andexanet alfa
Debate the evidence associated with the use of andexanet alfa and 4-factor PCC for ICH reversal
Evaluate the use of contemporary clinical trial data to determine optimal therapy for factor Xa-associated ICH reversal

Presentations:

Andexanet Alfa Is Preferred for Intracerebral Hemorrhage Management
Four-Factor PCCs Are Preferred for Intracerebral Hemorrhage Management
Wrap-Up and Summary