• Katie A Parsels, Robert W Seabury, Stephanie Zyck, Christopher D Miller, Satish Krishnamurthy, William Darko, Luke A Probst, Julius Gene Latorre, Gregory M Cwikla, and Elizabeth A Feldman.
• Upstate University Hospital, Department of Pharmacy, Syracuse, NY, USA. Electronic address: parselsk@upstate.edu.
• Am J Emerg Med. 2022 May 1; 55: 16-19.

BackgroundThere is limited information directly comparing andexanet alfa (AA) versus four-factor prothrombin complex concentrate (4F-PCC) in intracranial hemorrhage (ICH) on apixaban or rivaroxaban.ObjectiveThe objective of this study was to compare the effectiveness and safety of AA versus 4F-PCC in ICH on apixaban or rivaroxaban.MethodsThis retrospective, matched, cohort analysis was conducted at a single healthcare system. Patients were matched based on baseline ICH volume. The primary outcome was good or excellent ICH hemostasis, which was defined as a 35% or less increase in ICH volume within 24 h following AA or 4F-PCC administration. The secondary outcome was thrombotic events within 14 days following AA or 4F-PCC administration.ResultsIn total, 26 AA and 26 4F-PCC patients were included in this matched cohort analysis. Both groups had comparable rates of good or excellent ICH hemostasis (AA: 92.3% vs. 4F-PCC: 88.5%, p = 1.000). Thrombotic events within 14-days were not significantly different (AA: 26.9% vs. 4F-PCC: 11.5%, p = 0.159).Conclusion And RelevanceThis study found no significant differences in good or excellent ICH hemostasis within 24-h or new thrombotic events within 14-days in a cohort given AA or 4F-PCC for ICH while on apixaban or rivaroxaban. However, this single-center analysis is underpowered due to sample size constraints, therefore further high-quality research comparing AA safety and effectiveness versus 4F-PCC is needed.Copyright © 2022. Published by Elsevier Inc.

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