Andexanet alfa was associated with an odds ratio of 2.01 for excellent or good hemostatic efficacy compared to 4-factor prothrombin complex concentrate in patients with factor Xa inhibitor-associated bleeding, though this difference was not statistically significant.
Cohort (n=100)
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Does andexanet alfa improve hemostatic efficacy and clinical outcomes compared to 4F-PCC in adult patients with factor Xa inhibitor-associated bleeding?
In a small retrospective feasibility study of patients with factor Xa inhibitor-associated bleeding, andexanet alfa and 4F-PCC showed statistically similar rates of hemostatic efficacy, survival, and thrombotic events, though the study was underpowered for definitive conclusions.
Odds Ratio: 2.01 (95% CI 0.67–6.06)
Tasa de eventos absoluta: 84% vs 72%
Background: There are no randomized trials comparing andexanet alfa and 4 factor prothrombin complex concentrate (4F-PCC) for the treatment of factor Xa inhibitor (FXa-I)-associated bleeds, and observational studies lack important patient characteristics. We pursued this study to demonstrate the feasibility of acquiring relevant patient characteristics from electronic health records. Secondarily, we explored outcomes in patients with life-threatening FXa-I associated bleeds after adjusting forthese variables.Methods: We conducted a multicenter, chart review of 100 consecutive adult patients with FXa-I associated intracerebral hemorrhage (50) or gastrointestinal bleeding (50) treated with andexanet alfa or 4F-PCC. We collected demographic, clinical, laboratory, and imaging data including time from last factor FXa-I dose and bleed onset.Results: Mean (SD) age was 75 (12) years; 34% were female. Estimated time from last FXa-I dose to bleed onset was present in most cases (76%), and patients treated with andexanet alfa and 4F-PCC were similar in baseline characteristics. Hemostatic efficacy was excellent/good in 88% and 76% of patients treated with andexanet alfa and 4F-PCC, respectively (P = 0.29). Rates of thrombotic events within 90 days were 14% and 16% in andexanet alfa and 4F-PCC patients, respectively (P = 0.80). Survival to hospital discharge was 92% and 76% in andexanet alfa and 4F-PCC patients, respectively (P = 0.25). Inclusion of an exploratory propensity score and treatment in a logistic regression model resulted in an odds ratio in favor of andexanet alfa of 2.01 (95% confidence interval 0.67–6.06) for excellent/good hemostatic efficacy, although the difference was not statistically significant.Conclusion: Important patient characteristics are often documented supporting the feasibility of a large observational study comparing real-life outcomes in patients with FXa-I-associated bleeds treated with andexanet alfa or 4F-PCC. The small sample size in the current study precluded definitive conclusions regarding the safety and efficacy of andexanet alfa or 4F-PCC in FXa-I-associated bleeds.
Singer et al. (Tue,) conducted a cohort in Factor Xa inhibitor-associated bleeding (intracerebral hemorrhage or gastrointestinal bleeding) (n=100). Andexanet alfa vs. 4-factor prothrombin complex concentrate (4F-PCC) was evaluated on Excellent/good hemostatic efficacy (OR 2.01, 95% CI 0.67-6.06). Andexanet alfa was associated with an odds ratio of 2.01 for excellent or good hemostatic efficacy compared to 4-factor prothrombin complex concentrate in patients with factor Xa inhibitor-associated bleeding, though this difference was not statistically significant.