2) Your faithful correspondent and faculty is #emergencymedicine specialist and #thrombosis
— cardio-met (@cardiomet_CE) October 9, 2023
researcher Charles Pollack MD @md_pollack from @UMMCnews. You can earn 0.5hr CE/#CME just from following this 🧵! Happy #WSC23023 eve! pic.twitter.com/o9nP9K5GG4
4) The eagerly anticipated top-line results of #ANNEXa_I will be presented here at #WSC2023 on Tues, & 🔑investigator @Ash_Shoamanesh, #stroke #neurologist @HamHealthSci will bring you the info in a second live #tweetorial. Today it seems useful to put this trial into context. pic.twitter.com/wucRS7fgMA
— cardio-met (@cardiomet_CE) October 9, 2023
6) Unfortunately, the rate of #ICH among pts taking #DOACs is NOT zero; ICH is estimated to occur in 0.1-0.2% (1-2 per 1000) DOAC-treated pts each year. See 🔓https://t.co/209p7y8L9s.
— cardio-met (@cardiomet_CE) October 9, 2023
The 30-day case-mortality rate for DOAC-related ICH is ~25%: https://t.co/apQbA5KZBf pic.twitter.com/VoI8LXBijB
8) Thus to support the relative safety of #DOACs even more, much work has been done to identify the optimal approach to restore hemostasis safely, quickly, and reliably in patients with DOAC-associated #ICH.
— cardio-met (@cardiomet_CE) October 9, 2023
10) #Andexanet_alfa is a recombinant, catalytically inactive form of #FXa that acts as a "decoy" to bind and sequester factor Xa inhibitors. This leads to reversal of FXa activity that can be life-saving in major bleeding. It is specific for anti-FXa-#DOAC anticoagulation. pic.twitter.com/oP0qTP5vTE
— cardio-met (@cardiomet_CE) October 9, 2023
12) Andexanet was provisionally approved by @US_FDA based on a series of open-label cohort studies such as #ANNEXa_4 (🔓 https://t.co/4MlyxDqYi9). Endpoint driven dually by measured anti-#FXa activity and clinical + radiographic measures of #hemostasis.
— cardio-met (@cardiomet_CE) October 9, 2023
14) Based on the #Sarode criteria, hemostatic efficacy at 12 hrs was “excellent” in 70% & 67% & “good” in 7% & 15% for spontaneous (n=99) or traumatic (n=70) 🩸, respectively. 21 of 227 (9.3%) pts had thromboembolic events w/in 30d, including DVT (n=8), stroke (n=1) & MI (n=2). pic.twitter.com/oMynNYXi20
— cardio-met (@cardiomet_CE) October 9, 2023
16)There was no statistically significant difference in mortality for #andexanet (24%) vs #PCC (26%). TE events were ⬆️ with andexanet (14% vs 8%). Reversal similar for andexanet & PCC (77% vs 75%), but study quality with andexanet was higher.
— cardio-met (@cardiomet_CE) October 9, 2023
18) What is natural hx of #DOAC-related bleeding? In the #RASUNOA registry of pts w/ #ICH, 17/45 (38%) pts with #DOAC – related #ICH had ≥ 33% relative ⬆️or ≥ 6mL absolute ⬆️including 5/17 (29%) pts that did not get reversed. https://t.co/J7Ffy1EdnQ via @JAMANeuro
— cardio-met (@cardiomet_CE) October 9, 2023
20) The @neurocritical Rx Study Group published a multi-center, retrospective study of 433 pts with #DOAC – related #ICH who received #PCC in @CircAHA. They found that ~82% had excellent or good hemostasis and ~4% had a thrombotic complication. https://t.co/B3IUdYeiAz
— cardio-met (@cardiomet_CE) October 9, 2023
22) A meta-analysis in @critcaremed found the weighted mean effectiveness for #andexanet was 71% at 24h vs 76% for #PCC. The weighted mean thrombosis rate was 10.7% for Andexanet vs 3.1% for PCC, but 🚫sig differences after controlling for confounders https://t.co/D9Q8Rs6LF6 pic.twitter.com/lviD2VrMeL
— cardio-met (@cardiomet_CE) October 9, 2023
26) We are ready for more definitive answers from #ANNEXa_I, an RCT between #andexanet & usual care in pts with #ICH on #DOACs or indirect SC/IV anticoagulants.https://t.co/fkQcK3AvYn
— cardio-met (@cardiomet_CE) October 9, 2023
That’s the trial on which we’ll be reporting tomorrow!
28a) Meanwhile, as those data emerge, @American_Heart 🫀 2022 Guidelines consider #andexanet as a reasonable option in #ICH (COR: 2a, LOE: B-NR, 🔓https://t.co/oJVvgOWWCy. pic.twitter.com/oiRX3m3bNx
— cardio-met (@cardiomet_CE) October 9, 2023
28c) @ACEPnow #emergencymedicine guidelines https://t.co/AsfXgKzlT8 also recommend a specific reversal such as #andexanet over non-specific reversal strategies such as 4 Factor #PCC, as first-line therapy for reversal of anti-Xa DOAC associated bleeding. pic.twitter.com/Gh4IWDib6h
— cardio-met (@cardiomet_CE) October 9, 2023
30) Find out by doing 3⃣ things:
— cardio-met (@cardiomet_CE) October 9, 2023
First, go to https://t.co/6sb8aUmcC8 & claim your🆓CE/#CME certificate for 0.5h credit; you just earned it!
Second, FOLLOW US for more great #MedEd!
Third, TUNE IN TOMORROW for a live report on the #ANNEXa_I results from #WSC2023
31b) It's c, an inactive #FXa mimic to which DOACs are bound more avidly than they are to native FXa. #Andexanet is a specific and concentration-dependent competitive reversal agent for the anti-FXa #DOACs.
— cardio-met (@cardiomet_CE) October 9, 2023
32b) Kinda tricky, eh? The correct answer is d. Only #andexanet_alfa is authorized for reversal of anti-FXa DOAC anticoagulation in major 🩸, and as yet NO agent has been approved for pre-emptive reversal of DOACs in nonbleeding but anticoagulated patients prior to surgery.
— cardio-met (@cardiomet_CE) October 9, 2023
33) See you tomorrow–with all the 🔥 news from #WSC2023! pic.twitter.com/0RX4TWYyJa
— cardio-met (@cardiomet_CE) October 9, 2023