{
  "abstract": "Aims and Objectives Intracerebral haemorrhage (ICH) in patients on direct oral anticoagulants (DOACs) presents a significant clinical challenge. In 2020 the Scottish Medicines Consortium accepted the use of Andexanet alfa for the reversal of DOAC related uncontrolled or life threatening bleeding, including ICH. Andexanet alfa improves haemostasis and reduces haematoma expansion compared to normal care (often with pro-thrombin concentrate) but this may not translate to clinical benefit. Many aspects of Andexanet alfa use in patients with ICH, including type and timing of treatment, remain under investigation.Method and Design This retrospective analysis of adult (≥16 years) patients presenting to the ED of Aberdeen Royal Infirmary compares clinical characteristics, treatment, and outcomes of patients with non-traumatic ICH on DOACs who received Andexanet versus those who did not. Data were extracted from institutional records and summarised in tabular format.Results and Conclusion Between August 2020 and September 2024, 86 patients presented to the ED with DOAC related ICH, of whom 49 (57%) received Andexanet alfa ( table 1). Compared with those who did not, patients who did receive Andexanaet alfa had a higher mean GCS on presentation (13.2 v 10.6), smaller mean ICH volume on CT scan (25.6 mls v 32.0 mls), and, at 90 days, reduced mortality (35% v 70%), and improved functional outcome (median mRS 4.0 v 6.0). Andexanet alfa was also associated with fewer bleeding complications (2% v 11%) but more thrombotic events (8% v 3%). This study highlights the reassuring finding that clinicians are making discriminatory clinical judgements as to who may best benefit from treatment with Andexanet alfa. There is scope for clinical guidance to become much more refined and take in to account the significant cost associated with administration.Abstract 3934 Table 1Population demographics Andexanet No Andexanet Patents, number (n) 4937Male, n (%)28 (57)17 (46)Female, n (%)21 (43)20 (54)Age, years, mean (SD)79 (11)83 (8)Weight, kg, mean (SD)78 (21)67 (20) Pre-morbid function Modified Rankin Scale (mRS), median [IQR]2.0 [2.0-3.0]3.0 [2.0-4.0]Clinical Frailty Score, median [IQR]4.0 [3.0-5.0]5.0 [3.5-5.5]Charleson Score, median [IQR]6.0 [4.0-7.8]6.0 [4.5-7.5] DOAC, n (%) Apixaban30 (61)18 (49)Rivaroxaban16 (33)11 (30)Edoxaban3 (6)8 (22) Time since last DOAC, n (%) 0-8 hours19 (39)13 (35)8-15 hours20 (41)13 (35)15-24 hours6 (12)9 (24)>24 hours4 (8)2 (5) Mode of Arrival, n (%) SAS47 (96)35 (95)Self2 (4)2 (5) Clinical Parameters at presentation GCS, mean (SD)13.2 (2.5)10.6 (4.9)Systolic BP, mmHg, mean (SD)173.6 (31.9)169.1 (33.2)Diastolic BP, mmHg, mean (SD)97.6 (18.6)96.4 (21.5)NEWS Mean (SD)3.7 (2.8)4.7 (3.3) CT findings Intraventricular Haemorrhage, n(%)22 (45)16 (43)ICH volume, mls, mean (SD)25.6 (35.7)32.0 (35.6)Symptom onset to CT, mins, median [IQR]175 [1010 – 314]178 [139 – 515] Outcomes Mortality @ 30 days, n (%)17 (35)26 (70)mRS @ 30 days, median [IQR]5.0 [4.0-6.0]6.0 [5.0-6.0]Length of Stay, days, median [IQR]20 [4.5-78.0]7.0 [1.0-21.0]Bleeding complication @ 30 days, n (%)1 (2)4 (11)Thrombotic complication @ 30 days, n (%)4 (8)1 (3)Mortality @ 90 days, n (%)17 (35)26 (70)mRS at @ 90 days, median [IQR]4.0 [3.5-6.0]6.0 [5.0-6.0]Home Days @ 90 days, median [IQR]0 [0-46]0 [0-0]",
  "authors": [
    {
      "affiliations": [
        "Aberdeen Royal Infirmary - NHS Grampian"
      ],
      "name": "Emily Anderson"
    },
    {
      "affiliations": [
        "Aberdeen Royal Infirmary - NHS Grampian"
      ],
      "name": "Jamie Cooper"
    },
    {
      "affiliations": [
        "Aberdeen Royal Infirmary - NHS Grampian"
      ],
      "name": "Mary-Joan MacLeod"
    },
    {
      "affiliations": [
        "Aberdeen Royal Infirmary - NHS Grampian"
      ],
      "name": "Karla Carter"
    },
    {
      "affiliations": [
        "Aberdeen Royal Infirmary - NHS Grampian"
      ],
      "name": "Janice Irvine"
    }
  ],
  "title": "3934 Use of Andexanet-Alfa in non-traumatic intracerebral bleeds for patients on direct oral anticoagulants in Aberdeen royal infirmary: a retrospective analysis",
  "uid": "3fe41d4f-0f1a-557d-9a26-fd8407cec7e9"
}