Mixed Results for Factor Xa Reversal Agent in ICH: ANNEXA-I

The ANNEXA-I trial evaluated the factor Xa inhibitor reversal agent, andexanet, in patients with intracerebral hemorrhage taking factor Xa inhibitor anticoagulants. Results showed better control of hematoma expansion with andexanet but increased risk of thrombotic events, particularly ischemic stroke. The primary endpoint was achieved in a higher percentage of patients receiving andexanet compared to usual care. However, there were no significant differences in functional outcomes or death within 30 days between the groups. Critics noted the challenge in determining the potential net benefit of andexanet treatment due to uncertain clinical effects. The study was supported by various pharmaceutical companies and lead author Dr. Connolly received grants and consultancy fees from AstraZeneca.

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