![]() (Korebey 2021) These studies were retrospective in design and are subject to inherent limitations. They concluded that 4F-PCC is equivalent to, if not superior, in outcomes when used for the reversal of factor Xa inhibitor associated-intracranial hemorrhage. sought to compare their data on 4F-PCC to the ANNEXA-4 trial. (Ammar 2021, Pham 2022, Parsel 2022) However, Korebey et al. Recent comparative studies have found no statistical difference in hemorrhage expansion or thromboembolic complications when either 4F-PCC or AA were used for factor-Xa inhibitor-associated-ICB. ![]() The question remains-Which reversal agent is ideal in anticoagulant-associated intracranial bleeding (ICB)? (Connolly 2019) However, the study did not compare the reversal agent to 4F-PCC, which raised questions about its safety and effectiveness. The ANNEXA-4 trial concluded that AA was an effective reversal agent in factor Xa-inhibitor-associated bleeding, with 82% of patients demonstrating excellent or good hemostasis at 12 hours. (Xian 2019) 4-Factor Prothrombin Complex Concentrates (4F-PCC), or K-Centra, is a derivative of human plasma and is explicitly used to reverse vitamin K antagonists such as warfarin and non-specifically in the reversal of DOACs.Īndexanet alfa (AA) is a decoy protein specific to the emergent reversal of Factor Xa inhibitor-associated bleeding. BACKGROUND: Direct oral anticoagulants (DOACs) such as rivaroxaban and apixaban have become more prevalent in the aging population and are associated with intracranial bleeding at rates up to 4.2%.
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