Key Takeaways From ANNEXA-I Study

Opinion
Video

Dr Connolly highlights the cautious patient selection and the significance of reducing hematoma expansion for improved outcomes in cases of intracerebral hemorrhage (ICH) associated with the use of a reversal agent for factor Xa inhibitors.

Stuart J Connolly, MD, FRCPC, highlights the efficacy of andexanet in reducing hematoma expansion but acknowledges its association with increased ischemic stroke risk. Dr Connolly emphasizes the need for careful patient selection to optimize benefits and minimize risks, particularly for those at higher risk of hematoma expansion. The discussion outlines the significance of andexanet as the only reversal agent with a phase three trial, contrasting it with limited data for other treatments. The discussion also examines the ANNEXA-I study, revealing an interim analysis supporting andexanet's efficacy, leading to an early study termination. The expert underscores that this termination doesn't significantly impact the study's integrity. He stresses the drug's potential impact on intracerebral hemorrhage outcomes but underscore the importance of cautious usage to mitigate ischemic stroke risks, especially in patients with predisposing conditions like atrial fibrillation and previous strokes. Ultimately, Dr Connolly foresees andexanet playing a crucial role in clinical practice, expecting guidelines to provide comprehensive instructions for its usage. The urgent need to minimize hematoma expansion due to its severe impact on mortality in intracerebral hemorrhage is highlighted throughout the discussion.

Video synopsis is AI-generated and reviewed by NeurologyLive editorial staff.

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