Andexanet alfa showed no differences in neuroimaging stability or thrombotic events compared with 4F-PCC, but some studies suggested it may be superior for reducing mortality.
Systematic Review
Does Andexanet alfa improve bleeding control and reduce mortality compared to four-factor prothrombin complex concentrate in patients with factor Xa inhibitor-associated intracranial hemorrhage?
This systematic review suggests Andexanet alfa may offer a mortality benefit over 4F-PCC for reversing factor Xa inhibitor-associated intracranial hemorrhage, though data are limited to retrospective studies.
Background/Objectives: There are limited data on the risks and benefits of using Andexanet alfa (AA) compared with four-factor prothrombin complex concentrate (4F-PCC) for the reversal of factor Xa inhibitor-associated intracranial hemorrhage (ICH). Our aim was to describe a compilation of the information available in the literature to date. Methods: PubMed, Embase, Web of Science (Clarivate Analytics) and the Cochrane Central Register of Controlled Trials were searched until December 2023. Following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines, our systematic literature review included studies that were retrospective in design and evaluated both drugs to control bleeding and complications (death and thromboembolic events). Two researchers re-examined the studies for relevance, extracted the data and assessed the risk of bias. No meta-analyses were performed for the results. Results: In this limited patient sample, we found no differences between published articles in terms of neuroimaging stability or thrombotic events. However, some studies show significant differences in mortality, suggesting that one of the AAs may be superior to 4F-PCC. Conclusions: Our qualitative analysis shows that AA has a better efficacy profile compared with 4F-PCC. However, further studies monitoring these patients and a multicenter collaborative network dedicated to this topic are needed.
Ferreira et al. (Fri,) conducted a systematic review in factor Xa inhibitor-associated intracranial hemorrhage. Andexanet alfa vs. four-factor prothrombin complex concentrate (4F-PCC) was evaluated on Bleeding and complications (death and thromboembolic events). Andexanet alfa showed no differences in neuroimaging stability or thrombotic events compared with 4F-PCC, but some studies suggested it may be superior for reducing mortality.
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