ESOC 2022 | Anticoagulation reversal prior to thrombolysis

Senta Frol, MD, PhD, University Medical Centre Ljubljana, Slovenia, discusses the use of andexanet alfa for reversing anticoagulation from apixaban or rivaroxaban in patients with stroke. The recombinant human factor Xa protein binds specifically to apixaban or rivaroxaban and is indicated for patients who suffer intracranial bleeding on these agents. However, current guidelines advise against the use of andexanet alfa for anticoagulation reversal in patients with acute ischemic stroke in the thrombolytic window, due to the high rate of thrombotic complications. More data on the use of andexanet alfa to neutralize anticoagulant activity prior to thrombolysis is needed, as well as tackling issues surround health economics. This interview took place at European Stroke Organisation Conference 2022 in Lyon, France.