Reversing Oral Anticoagulation in Intracerebral Hemorrhage

• Published in: The New England journal of medicine Vol. 390; no. 19; pp. 1815 - 1816
• Main Authors: Smith, Wade S., Hemphill, J. Claude
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 16.05.2024
• Subjects: Administration, Oral; Antagonists; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Cerebral Hemorrhage - chemically induced; Cerebral Hemorrhage - drug therapy; Clinical trials; Coagulation; Emergency Medicine; Emergency Medicine General; Factor Xa; Factor Xa Inhibitors - adverse effects; Hematology; Hematoma; Hemorrhage; Humans; Ischemia; Neurology; Neurosurgery; Oncology; Randomized Controlled Trials as Topic; Stroke; Vitamin K
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMe2403726

Intracerebral hemorrhage remains a challenging disorder to treat. Hematoma expansion is a recognized complication that worsens outcomes and is especially common in patients who are taking oral anticoagulant medications. With the shift in practice from vitamin K antagonists to direct-acting oral anticoagulants, especially factor Xa inhibitors such as apixaban and rivaroxaban, the need to identify the best strategy to reverse their effects has become compelling. Andexanet binds and sequesters factor Xa molecules, and in an open-label study of this agent in patients with acute major bleeding at any site, anti–factor Xa activity was reduced and good or excellent hemostatic efficacy . . .