Dados do Trabalho

Título

Andexanet Alfa Reduces Hematoma Expansion in Factor Xa Inhibitor-Associated Intracranial Hemorrhage: A Systematic Review and Single Arm Meta-Analysis

Objetivo

Patients using factor Xa inhibitors have a higher risk of negative outcomes in intracranial hemorrhage associated with hematoma expansion. Although the drug andexanet alfa was developed for rapid reversal of anticoagulation, there is still a lack of evidence supporting its use. This meta-analysis aims to determine the effect of andexanet alfa on hemostatic efficacy in patients with intracranial hemorrhage using factor Xa inhibitors.

Métodos

We systematically searched PubMed, Embase, and Cochrane Central up to May 2024. We included studies with patients who received any factor Xa inhibitor or enoxaparin. Outcomes of interest were hemostatic efficacy at 12 hours (determined by <35% hematoma expansion), 30-day mortality, and thrombotic events.

Resultados

We included four observational studies and one randomized controlled trial comprising 457 patients. All studies reported a median Glasgow Coma Scale score ≥ 14. Andexanet alfa achieved hemostatic efficiency in 79.23% (95% CI: 75.22 - 82.74; I²=0%) of patients. Thrombotic events happened in 8.29% (95% CI: 5.92 - 10.96; I²=0%) of patients. Overall 30-day mortality was 15.06% (95% CI: 6.41 - 26.11; I²=83%).

Conclusão

In patients with intracranial hemorrhage taking factor Xa inhibitors, andexanet alfa is associated with a high rate of both hemostatic efficiency and thrombotic events.