Efficacy of andexanet alfa in non-surgical patients with spontaneous DOAC related intracerebral hemorrhage

Introduction

In 2018, andexanet alfa (Andexxa) became FDA approved as an anti-factor Xa inhibitor reversal agent for patients who require the reversal of anticoagulation due to rivaroxaban (Xarelto) or apixaban (Eliquis). A key consideration when utilizing Andexxa is its notably high cost. This study’s objective is to assess the clinical benefit of Andexxa on patients with spontaneous intracerebral hemorrhages (ICH) who did not undergo neurosurgical intervention.

Methods

For this retrospective study, the American Heart Association stroke registry was queried for patients admitted to MetroHealth for ICH between 2020 and 2023. The medical record was accessed to obtain more specific information for patients. Analyses were done to assess differences between groups.

Results

45 nonsurgical patients on a DOAC with spontaneous ICH between 2020 and 2023 were identified. There were no significant differences in baseline demographics. There were no significant differences in the baseline ICH score or the NIHSS. The Andexxa group trended towards a higher initial ICH volume (19 cc vs 7 cc; p = 0.16). We observed no significant differences in the hospital length of stay, ICH expansion volume between the two groups (2.4 cc vs 0.21 cc; p = .26) or mortality rates. Total pharmacy charges for Andexxa during the study period were $464,640.00.

Conclusion

In our study, patients who received Andexxa therapy and non-surgical management of spontaneous ICH showed no difference in ICH expansion within 24 h but had increased cost of care. Further studies should examine whether Andexxa is of clinical value for patients with spontaneous ICH.