ReviewResearch and practice in thrombosis and haemostasis2025
Andexanet alfa vs standard of care for factor Xa inhibitor-induced intracranial hemorrhage-a systematic review and meta-analysis.
Review in Research and practice in thrombosis and haemostasis, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Thrombotic and ischemic event reporting with anticoagulant reversal agents: a multi-agent FAERS pharmacovigilance study.Journal of thrombosis and thrombolysis · 2026Article
- Comment on "Effect of spiritual care on the quality of life in patients who underwent intracranial hemorrhage surgery: a randomized controlled trial".International journal of surgery (London, England) · 2026Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Direct oral anticoagulants are activated factor (F)X (FXa) or thrombin inhibitors. Patients on FXa inhibitors are at increased risk for major bleeding events that require anticoagulation reversal. Andexanet alfa is a FXa inhibitor reversal agent, potentially offering better efficacy compared to standard of care options. Objectives: To conduct a systematic review and meta-analysis comparing the efficacy and safety of andexanet alfa vs standard of care for reversing FXa inhibitor-induced intracranial hemorrhage. Methods: Random-effects meta-analysis. Ovid Medline, EMBASE, and CINAHL were searched from inception until February 1, 2025. Primary outcomes included hemostatic efficacy, thrombotic events, and mortality. Subgroup analyses isolated studies using 4-factor prothrombin complex concentrate as standard of care and the Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors (ANNEXA-4) trial's definitions of hemostatic efficacy. Results: A total of 3039 studies were identified, with 23 studies (1 randomized controlled trial, 452 participants; 22 nonrandomized, 4085 participants) included in the final analysis. Thirteen studies assessed hemostatic efficacy, with a pooled odds ratio of 1.68 (95% CI, 1.2, 2.36; Conclusion: Our meta-analysis found low-certainty evidence supporting improved hemostatic efficacy with andexanet alfa compared with standard of care, with a decrease in mortality and no effect on thrombotic complications. Further randomized data is required to establish a conclusive clinical benefit favoring andexanet alfa.
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