How do we implement ANNEXXa-I into our Clinical Practice?

November 30, 2023
For acute care physicians, anticoagulated patients presenting with intracranial hemorrhage (ICH) is an incredibly challenging clinical scenario. ANNEXa-I is a randomized, controlled, clinical trial which provides clinicians with important information on appropriate reversal of anticoagualtion to optimally care for these patients.
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Real World Evidence for Management of Severe Bleeding in the Anticoagulated Patient: Impact of Specific Reversal Therapy for Intracranial Hemorrhage and Gastrointestinal Bleeding

July 28, 2023

Real World studies can provide the foundational support necessary for clinicians to effectively manage anticoagulated patients with severe, often life-threatening intracranial and gastrointestinal bleeding. While randomized controlled clinical trials have provided the initial data necessary for appropriate use of reversal agents such as andexanet alfa for Factor Xa associated bleeding, broader studies enrolling thousands of patients, many with significant co-morbidities, are extremely valuable to clinicians. New information regarding the randomized controlled trial ANEXXA-I, which was halted due to andexanet alfa efficacy, provides additional information supporting reversal therapy for severe bleeding.

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The Role of Real World Evidence in Driving Clinical Care for Anticoagulated Patients with Life-Threatening Bleeding

March 31, 2023
Experts in Emergency Medicine, Pharmacy, and Neurocritical Care describe the impact of real world evidence on the care of life-threatening bleeding in the anticoagulated patient. While clinical trial data remain the standard for clinicians, real world data provide important additional information on the use of a particular Repletion or Reversal therapy for these patients.
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What Are the Barriers to Success When Implementing Care Pathways for ICH Patients?

July 12, 2022

ICH remains deadly and pathways matter but they aren't always what we need and barriers can be overcome with knowledge.

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How Do We Coordinate Care Within Our Hospitals To Improve Outcomes in Hemorrhagic Stroke Patients?

July 5, 2022
Coordinating the necessary care for hemorrhagic patients is complicated- learn the ropes from experts on the UC Stroke Team. "Smoother, faster better" is the name of the game.
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Jul 28

Real World Evidence for Management of Severe Bleeding in the Anticoagulated Patient: Impact of Specific Reversal Therapy for Intracranial Hemorrhage and Gastrointestinal Bleeding

Haemin Go posted on 7/28/2023


Moderator: W. Brian Gibler, MD, FACEP, FACC, FAHA
Other Participants: Paul P. Dobesh, PharmD, FACC, FAHA, FCCP, BCPS, BCCP; Gregory J. Fermann, MD; Natalie Kreitzer, MD, MS

Recent Real World Evidence from a large observational study of 4,395 patients from 354 hospitals across the United States presented at the Society for Academic Emergency Medicine and International Society of Thrombosis and Hemostasis meetings has provided critical information for clinicians caring for patients with severe gastrointestinal and intracranial bleeding. With large gastrointestinal bleeding and intracranial hemorrhage cohorts, this study has demonstrated that andexanet alfa is superior to 4-Factor PCCs in managing severe bleeding in patients anticoagulated with Factor Xa inhibitors. In addition, patients with heart failure, liver failure, and chronic kidney disease (CKD) typically excluded from a randomized controlled trial showed benefit in this observational study. In addition, ANEXXA-I, a randomized controlled trial of andexanet alfa versus 4-Factor PCCs for treatment in intracranial hemorrhage, was stopped by the data safety and monitoring board of the trial due to efficacy of the andexanet alfa treatment arm.


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