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ISC 2024 | Secondary analyses from ANNEXA-I: identifying predictors of hematoma expansion and thrombotic events

Ashkan Shoamanesh, McMaster University, McMaster University, shares secondary analyses from the ANNEXA-I trial (NCT03661528) presented at the International Stroke Conference 2024. ANNEXA-I was a multicenter study evaluating the safety and efficacy of andexanet alfa in patients with acute intracerebral hemorrhage (ICH) treated with factor Xa inhibitors, demonstrating a significant improvement in hemostatic efficacy outcomes versus standard of care. Secondary analyses focused on identifying predictors of hematoma expansion and thrombotic events in patients with FXa inhibitor-associated ICH. Results showed an inverse association between time from symptom onset to treatment and hematoma growth, as well positive associations between hematoma growth and baseline ICH volume and pre-scan hematoma growth rate. Patients with larger baseline ICH volumes or higher growth rates experienced greater absolute benefits from andexanet alfa. Importantly, none of the analyzed metrics were associated with excess thrombotic events. These findings suggest that andexanet alfa may effectively prevent hematoma expansion in high-risk patients. Further analysis focusing on the clinical consequences of ischemic stroke versus hematoma expansion is planned, which will provide additional insights for clinical decision-making in FXa inhibitor-associated ICH. This interview took place during the International Stroke Conference 2024 in Phoenix, AZ.

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