What question did this study set out to answer?

This research assesses the time to treatment for reversal agents in patients with anticoagulant-associated spontaneous intracerebral hemorrhage (ICH).

March 26, 2026

430: Door-to-Treatment Time of Anticoagulant-Associated Spontaneous Ich

Key Points

This research assesses the time to treatment for reversal agents in patients with anticoagulant-associated spontaneous intracerebral hemorrhage (ICH).
Evaluated adults receiving andexanet alfa or prothrombin complex concentrates for spontaneous ICH.
Patients included were treated at a comprehensive stroke center, excluding transfers, late treatments, pregnancy, or incarceration.
Primary outcome focused on time to administration of reversal agents, with secondary outcomes including comparison of treatments and clinical pharmacist involvement.
Median time to treatment for 62 patients was 90 minutes, with only 25.8% treated within the 60-minute guideline.
Time to head CT was 7 minutes, while compounding time averaged 32.5 minutes.
No significant difference in treatment time between patients receiving andexanet alfa versus prothrombin complex concentrates, but PCCs had faster compounding times.
Clinical pharmacist involvement may lead to quicker treatment times, although not statistically significant.

Abstract

Introduction: Anticoagulant associated intracerebral hemorrhage (ICH) is a serious condition with recommendations to administer reversal within 60 minutes. This medication use evaluation assessed time to treatment with andexanet alfa (AA) or 4-factor prothrombin complex concentrate (PCCs) in patients presenting with spontaneous ICH. Methods: Adults receiving AA or 4-factor PCCs at a comprehensive stroke center for anticoagulant associated spontaneous ICH were included. Exclusion criteria included transfers from outside facilities, administration after hospital day 1, pregnancy or incarceration. The primary outcome was time to administration of reversal agent. Secondary outcomes were a comparison of time to treatment with either AA or PCCs, comparison of compounding times, time to head computed tomography (CT), comparison of direct oral anticoagulant (DOAC) versus warfarin, and impact of clinical pharmacist involvement. Results: A total of 62 patients (51 AA; 11 PCCs) were included. The median time to treatment was 90 (IQR 59-145) minutes with 16 patients (25.8%) treated within 60 minutes. Time to head CT was 7 (IQR 0-30) minutes and drug compounding time was 32.5 (IQR 21-40) minutes. When comparing AA and PCCs there was no difference in time to treatment (88 57-135 vs 115 52-166 minutes p=0.38). PCCs demonstrated a faster drug compounding time (24 7-37 vs 33 24-41 minutes p=0.04). There was no statistical difference between warfarin and DOAC time to treatment (67 40-123 vs 90 [65.8-146 minutes p=0.22). 46 patients had clinical pharmacist involvement, and these patients received treatment faster than those without pharmacist involvement (84 54.3-131 vs. 107.5 87.3-160.5 minutes p=0.07). Pharmacist involvement had no impact on drug compounding time (32 20.8-37.8 vs 33 22.5-56.5 minutes p=0.4). Conclusions: Time to treatment of anticoagulant associated ICH was frequently not within the 60-minute recommendation indicating the need for further initiative to improve door to treatment times. Utilizing clinical pharmacists on the interdisciplinary team might improve door to treatment times in anticoagulant associated ICH.

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Cite This Study

Krabacher et al. (Sun,) studied this question.

synapsesocial.com/papers/69c4cdb6fdc3bde44891a6d7 https://doi.org/https://doi.org/10.1097/01.ccm.0001183716.94833.45

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