W. Brian Gibler, MD, FACEP, FACC, FAHA
Other Participants: MD, Paul P. Dobesh, PharmD, FACC, FAHA, FCCP, BCPS, BCCP; Gregory J. Fermann, MD; Natalie Kreitzer, MD, MS
An anticoagulated patient presenting to the Emergency Department or Neurocritical Care Unit with intracranial hemorrhage (ICH) represents one of the most challenging clinical cases faced by emergency physicians and neurointensivists. Reversal of anticoagulation associated with treatment using Factor Xa inhibitors requires understanding the action of a specific agent, andexanet alfa. The ANNEXa-I trial, a randomized, controlled clinical trial for patients with ICH on anticoagulation, was stopped early before study completion in June 2024 due to efficacy of the andexanet alfa treatment arm versus usual care. In October 2023, a presentation at the 2023 World Stroke Conference provided further information on the trial results. In this Podcast, the faculty discusses the implications of ANNEXa-I for optimal management of ICH in the Emergency Department and Neurocritical Care Unit.