2) This 🆓program is accredited for 0.5h CE/#CME for #physicians #physicianassociates #nurses #nurespractitioners #pharmacists and is supported by a grant from AstraZeneca. See statement of accreditation and faculty disclosures at https://t.co/gvXca4G9Xm.
— cardio-met (@cardiomet_CE) January 11, 2023
4) Unfortunately, despite their excellent safety profile, #DOACs can increase the risk of bleeding, the most life threatening of which is intracranial hemorrhage #ICH 🧠🚑🏥 pic.twitter.com/aNImIT6BHq
— cardio-met (@cardiomet_CE) January 11, 2023
6) 4F-PCC (#PCC) contains concentrated vitamin K-dependent coagulation factors (II, VII, IX, & X). But what exactly is #Andexanet_alfa (#Andexanet)?
— cardio-met (@cardiomet_CE) January 11, 2023
a. Monoclonal antibody against Factor Xa inhibitors
b. Recombinant Factor Xa decoy protein
c. Factor Xa concentrate
8) Great, now that we have a better understanding of our options let’s go back to our previous dilemma! In a patient presenting to the ED with #ICH while on #DOAC, which reversal agent is superior in terms of efficacy and/or safety, #Andexanet_alfa or #PCC?
— cardio-met (@cardiomet_CE) January 11, 2023
10) The #ANNEXA-4 substudy for #ICH (🔓https://t.co/HkY6OuowT6) evaluated #Andexanet in 227 🏥pts w/ #ICH. Anti-FXa activity 📉 in 93.8% of patients on #apixaban & in 92.6% on #rivaroxaban. Most patients had been on either apixaban (61.7%) or rivaroxaban (30.4%) before the #ICH. pic.twitter.com/CdnelTpM4H
— cardio-met (@cardiomet_CE) January 11, 2023
12) But what about other studies? A 2021 Meta-Analysis in JACC of studies with reversal agents for severe DOAC-associated 🩸(🔓https://t.co/p6c2zRj7bp) included a subgroup of 936 pts treated with #Andexanet. pic.twitter.com/I7I5MDjszP
— cardio-met (@cardiomet_CE) January 11, 2023
14) Although TE was higher for #Andexanet, there was high heterogeneity among studies. Anticoagulation was resumed ~11 days after admission among all pts. A rebound effect cannot be ruled out w/ #Andexanet after reversal, due to ⬆️thrombin generation (🔓https://t.co/lUKppEWxgH)
— cardio-met (@cardiomet_CE) January 11, 2023
15b) We might get some answers on superiority from #ANNEXA-I, in 2024, an RCT between #Andexanet & usual care in pts with #ICH on #DOACs or indirect SC/IV anticoagulants, in 2024.https://t.co/fkQcK3AvYn pic.twitter.com/PLWs4NsNPE
— cardio-met (@cardiomet_CE) January 11, 2023
17) Regarding GI 🩸, the 2022 @AmCollegeGastro–@CanGastroAssn guidelines recommend against the use of reversal agents (conditional recommendation, very low certainty of evidence, 🔓https://t.co/RKR6cgDUoF) pic.twitter.com/Ltkt5qsKVE
— cardio-met (@cardiomet_CE) January 11, 2023
19) @ACCinTouch 's 🆓 free, interactive, online tool can be very helpful in determining the optimal path for managing an acute 🩸 in pts on DOACs: See ManageAnticoag (🔓https://t.co/htSM0An2Yu) pic.twitter.com/4r8shUWIDa
— cardio-met (@cardiomet_CE) January 11, 2023
21) There is currently no indication to co-administer #Andexanet with a #PCC product (i.e. we would give one or the other, but never both)! pic.twitter.com/AGjDFFzCMx
— cardio-met (@cardiomet_CE) January 11, 2023
23) The ✔️ answer is d! Give low dose for pts who received lower dose of aFXa (rivaroxaban ≤10 mg, apixaban ≤5 mg) OR if ≥8 hrs since last dose; higher dose for those who received higher dose of aFXa (rivaroxaban >10 mg, apixaban >5 mg, or dose unknown) w/in 8 hrs pic.twitter.com/0rEhNvSrt0
— cardio-met (@cardiomet_CE) January 11, 2023
24b) An online dose calculator for #Andexanet can be helpful: https://t.co/pZpolHcQ0O pic.twitter.com/73vteLzqgV
— cardio-met (@cardiomet_CE) January 11, 2023
26a) While assessing anti-FXa activity calibrated for rivaroxaban or apixaban may help, the time of last dose taken is sufficient to guide dosing, as #ANNEXA_4 did not mandate #aFXa activity for #Andexanet administration.
— cardio-met (@cardiomet_CE) January 11, 2023
27a) Now let’s review the 🔑🥡🏡messages!
— cardio-met (@cardiomet_CE) January 11, 2023
👉Reversal of FXa inhibition must be done ASAP in #ICH + (only) in life-threatening GI 🩸!
👉Until a 🗣️to 🗣️ RCT, guidelines & other guidance documents recommend #Andexanet over #4F_PCC.
28) @AlexSpyropoul & @academiccme thank you for joining & learning with us! Now go to https://t.co/Zi1xlBdBNz and claim your 0.5h 🆓CE/#CME . . . and FOLLOW US for more education by #cardiometabolic experts!
— cardio-met (@cardiomet_CE) January 11, 2023