How do you decide when to use andexanet (ANDEXXA) for intracranial hemorrhage associated with factor Xa inhibitors?

The ANNEXA-I trial presents a mixed perspective. The data demonstrated that Andexanet is superior to standard care in reducing hematoma expansion for intracerebral hemorrhage associated with factor Xa inhibitors. This conclusion is based on an imaging-based primary endpoint, supported by previous studies linking imaging outcomes to better clinical results. However, non-imaging metrics within the trial's hemostasis efficacy group did not achieve statistical significance.

Additionally, the trial lacked sufficient power to assess statistical significance in long-term functional outcomes, limiting conclusions about the drug's overall effectiveness. Of particular concern is the statistically significant increase in thrombotic events, such as isch...