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) November 2, 2022
4a) They noted that #Andexanet or #PCC are reasonable options for #DOAC #reversal, but what data are available to guide clinicians in the use of specific DOAC reversal (Andexanet) and nonspecific factor #repletion (PCC)? A 🧵…
— cardio-met (@cardiomet_CE) November 2, 2022
4c) #Andexanet_alfa is a #recombinant modified human FXa decoy protein that is catalytically inactive but retains ability to bind FXa inhibitors in the active site with high affinity and a 1:1 stoichiometric ratio. pic.twitter.com/qx2iiyY2TT
— cardio-met (@cardiomet_CE) November 2, 2022
5) And now, a survey: In your view, which agent does the literature support for #DOAC reversal?
— cardio-met (@cardiomet_CE) November 2, 2022
a) #Andexanet
b) #PCC
c) Equally effective
d) Not sure… we need an #RCT!
7) They found that anti-factor #Xa activity decreased substantially by the end of the bolus and remained low at the end of infusion, although there was some rebound ⬆️at 4h. pic.twitter.com/YHaXm6lujp
— cardio-met (@cardiomet_CE) November 2, 2022
9) For #GIbleeds, excellent #hemostasis was declared by a ≤ 10% ⬇️ in the corrected H/h at 12 h, and good by a ≤ 20% ⬇️ with ≤ 2u of #FFP or #PCC. For #ICH, an ⬆️ volume of ≤ 20% at both 1h &12h after infusion was deemed excellent & an ⬆️ by ≤ 35% was deemed good pic.twitter.com/S0CLq4XzZV
— cardio-met (@cardiomet_CE) November 2, 2022
11) But, context? 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) November 2, 2022
13) 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) November 2, 2022
15) 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 was 10.7% for Andexanet vs 3.1% for PCC, but 🚫sig differences after controlling for confounders https://t.co/D9Q8Rs6LF6 pic.twitter.com/U5aua4oZkK
— cardio-met (@cardiomet_CE) November 2, 2022
17) A propensity score analysis in @crit_care found ⬆️odds of achieving hemostasis with #Andexanet (85.8% vs 68.1%; OR 2.73; 95% CI 1.16–6.42). The Andexanet cohort was derived from #ANNEXA-4. A synthetic #PCC arm was derived from an observational study. 🔓https://t.co/LDMjvTFE3E pic.twitter.com/b2PX3Kiiar
— cardio-met (@cardiomet_CE) November 2, 2022
19) Do these propensity-score analyses convince you?
— cardio-met (@cardiomet_CE) November 2, 2022
a) Yes: #Andexanet all the way
b) No: we need an RCT
c) I’ll stick with #PCC anyway
21) @namorrismd & @academiccme thank you for joining & learning with us! Now go to https://t.co/ewU526Mneb and claim your 0.5h 🆓CE/#CME . . . and FOLLOW US for more education by #cardiometabolic experts!
— cardio-met (@cardiomet_CE) November 2, 2022
Re our tweetorial posted this week, at https://t.co/laeB275ev7, please note that the figure incorrectly refers to #dabigatran as an anti-#FXa DOAC. It of course is not, The remainder of the figure is correct but the DOAC should be #apixaban or #rivaroxaban pic.twitter.com/yXb9YoPSfJ
— cardio-met (@cardiomet_CE) November 4, 2022