Abstract Details

Title Intracerebral Hemorrhage Severity Predicts Long-Term Functional Outcomes After Anticoagulation Reversal with Andexanet alfa

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-005

Objective To determine if intracerebral hemorrhage (ICH) severity in patients using direct oral anticoagulants (DOAC) predicts long-term functional outcomes after anticoagulation reversal with andexanet alfa (AA).

Background Devastating ICH can occur with DOAC use. Key management includes prompt anticoagulation reversal to prevent ICH extension. AA is targeted for reversal of factor Xa inhibitors. Due to high cost and safety concerns, selection of patients who can derive the greatest benefit according to clinical factors is essential.

Design/Methods

This was an IRB-approved retrospective study including consecutive patients (2018 - 2021) who presented with ICH in setting of DOAC use to stroke centers within a multi-site health system in the US. All patients who received AA were included. Demographics, ICH scores, NIHSS, DOAC type, and 90-day mRS were recorded. ICH severity was defined by ICH score. A favorable functional outcome was defined as a 90-day mRS 0-2. Statistical significance was determined using logistic regression.

Results 43 patients met inclusion criteria (mean age 76.0 +/-11.6, 46.5% women, 90.7% white, 34.9% rivaroxaban, 65.1% apixaban, premorbid mRS 1.7 +/- 1.8). Patients who had a favorable 90-day mRS presented with lower ICH scores (0.7 vs. 2.1, p=0.002), lower premorbid mRS (0.2 vs. 2.2, p=0.001), and lower NIHSS (4.7 vs. 12.1, p=0.030). Additionally, they were more likely to be discharged to home or rehab (80% vs. 35.5%, p=0.026). A higher ICH score was associated with lower odds of a favorable functional outcome at 90 days (OR=0.26, 0.08 - 0.63; p=0.011). For every 1-point increase in ICH score at presentation, the odds of favorable outcome at 90-days were reduced by 74%.

Conclusions ICH severity is a strong predictor of long-term functional outcomes in AA reversal. This study implicates targeted reversal with AA in patients presenting with lower ICH scores have more favorable long-term functional outcomes. Additional studies are needed comparing AA to alternative anticoagulation reversal strategies.

Authors/Disclosures
Nikita Chhabra, DO (Mayo Clinic) PRESENTER	Dr. Chhabra has nothing to disclose.
Johnny Cebak, DO, PhD (Mayo)	Dr. Cebak has nothing to disclose.
	No disclosure on file
Kara A. Sands, MD (University of Alabama at Birmingham, Department of Neurology)	Dr. Sands has nothing to disclose.
Harn Shiue, PharmD (Mayo Clinic Arizona Hospital)	Dr. Shiue has nothing to disclose.

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