Episode 299: 298. Do We Have a Reversal Drug for DOACs? ANNEXA or Andexanet
Questioning Medicine6 Jun 2024

Episode 299: 298. Do We Have a Reversal Drug for DOACs? ANNEXA or Andexanet

1° outcome: hemostatic efficacy = which was defined as;

(A) Hematoma expansion ≤ 35% at 12h

(B) increase in NIHSS ≤ 7 at 12h

(C) No rescue therapy 3-12h

Results hemostatic efficacy: 76.7% andexanet vs 64.6% usual care

30 day mortality: no difference

30 day Modified Rankin Score ≤3: no difference

Thrombotic events: almost x2 with andexanet 10.3% vs 5.6% - statistically significant. Most were strokes and MI - not trivial.

The question you should ask: How does effective is hemostatic efficacy as a marker for patient outcomes?? Yes, we don’t want the brain bleed to get bigger but patients don’t care if the bleed gets bigger if they still die or if they still are in a coma for the rest of their life.

We know from warfarin that increase in hematoma expansion leads to worse outcomes (https://pubmed.ncbi.nlm.nih.gov/21346218/). We don’t have clear data on this for the DOACs. HOWEVER, just because an expanding hematoma leads to a bad outcome that does not mean that giving a medication to decrease hematoma expansion leads to better survival or improvement in disability.

In fact the randomized, double-blind, placebo-controlled trial we have that gave recombinant activated factor VII for acute intracerebrall hemorrhage showed that rFVIIa significantly reduced the growth of the hematoma but failed to improve survival or functional outcome at 90 days. https://pubmed.ncbi.nlm.nih.gov/19959538/

So we have a trial that shows improvement in hematoma expansion. It shows no difference in mortality or Rankin scale and demonstrates twice the rates of thrombotic events.

Bottom line-- ANNEXA-I does not show clear evidence of clinical benefit but there is definite evidence of harm. The logical argument for hematoma expansion as an outcome is compelling but not proven for patient oriented outcomes.

Episoder(386)

Episode 360: 259. Urinary Retention Evaluation and Catheterization Algorithm for Adult Inpatients

Episode 360: 259. Urinary Retention Evaluation and Catheterization Algorithm for Adult Inpatients

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821168A team of researchers set out to change that by developing a comprehensive algorithm.The process involved a multidisciplinary panel ...

10 Jan 20257min

Episode 359: 258. Oral Antibiotics and Risk of Serious Cutaneous Adverse Drug Reactions

Episode 359: 258. Oral Antibiotics and Risk of Serious Cutaneous Adverse Drug Reactions

https://jamanetwork.com/journals/jama/article-abstract/2822097Design, Setting, and Participants  Nested case-control study using population-based linked administrative datasets among adults aged 66 ye...

3 Jan 20255min

Episode 358: 257. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention

Episode 358: 257. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention

https://www.nejm.org/doi/full/10.1056/NEJMoa2407001ConclusionsNo participants receiving twice-yearly lenacapavir acquired HIV infection. HIV incidence with lenacapavir was significantly lower than bac...

30 Des 20246min

Episode 357: 256. Medications for alcohol-use disorder and follow-up after hospitalization

Episode 357: 256. Medications for alcohol-use disorder and follow-up after hospitalization

Allaudeen N et al. Medications for alcohol-use disorder and follow-up after hospitalization for alcohol withdrawal: A multicenter study. J Hosp Med 2024 Dec; 19:1122. (https://doi.org/10.1002/jhm.1345...

27 Des 20245min

Episode 356: 255. Real-world use of glucocorticoids for adults hospitalized with community-acquired pneumonia

Episode 356: 255. Real-world use of glucocorticoids for adults hospitalized with community-acquired pneumonia

Real‐world use of glucocorticoids and clinical outcomes in adults hospitalized with community‐acquired pneumonia on medical wards - Malecki - 2024 - Journal of Hospital Medicine - Wiley Online Library...

23 Des 20246min

Episode 355: 254. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension

Episode 355: 254. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension

2024 ESC guidelines propose a simple new BP categorization: Non-elevated: less than 120/70 mm Hg in the office (pharmacological treatment is not recommended). Elevated: 120 to 139/70 to 89 mm Hg (phar...

20 Des 20248min

Episode 354: 253. Centralized Colorectal Cancer Screening Outreach in Federally Qualified Health Centers

Episode 354: 253. Centralized Colorectal Cancer Screening Outreach in Federally Qualified Health Centers

Question  Does adding centralized mailed fecal immunochemical testing and patient navigation to usual care improve colorectal cancer (CRC) screening in US federally qualified health centers? pragmatic...

18 Des 20247min

Episode 353: 252. 2.4 Million to Prevent 4 Hospitalizations!

Episode 353: 252. 2.4 Million to Prevent 4 Hospitalizations!

Packer M et al. Tirzepatide for heart failure with preserved ejection fraction and obesity. N Engl J Med 2024 Nov 16; [e-pub].https://doi.org/10.1056/NEJMoa2410027  In the industry-funded SUMMIT trial...

13 Des 202411min

Populært innen Helse

fastlegen
lydartikler-fra-aftenposten
rss-gukild-johaug
hvordan-har-du-det-mann
psykodrama
relasjonspodden-med-dora-thorhallsdottir-kjersti-idem
leger-om-livet
rss-garne-damer
foreldreradet
hjernesterk
hormonelle-frida
morten-ramm-lar-kakla-ga-til-du-sovner
rss-lopedrommen
bak-fasaden-en-reise-i-livet-med-sykepleier-ine
klimaks
g-punktet
rss-kull
rss-sunn-okonomi
helsetipspodden
sinnsyn