Andexanet Decreases Hematoma Expansion for Factor Xa Inhibitor–Associated Intracerebral Hemorrhage

Chronic oral anticoagulation with a factor Xa inhibitor is used to prevent thrombotic events but comes with increased hemorrhage risk. Anticoagulation-associated intracerebral hemorrhage presents a particular challenge, especially when there is early hematoma expansion, which is associated with worse outcomes. Andexanet alfa, a novel factor Xa inhibitor antidote, has been evaluated for acute major bleeding, but its safety and efficacy for anticoagulation-associated intracerebral hemorrhage has not been formally evaluated. Researchers now report results of the industry-funded ANNEXA-I trial, in which 530 patients who had taken factor Xa inhibitors within 15 hours before an acute intracerebral hemorrhage were randomly assigned to andexanet or…