false
Catalog
SCCM Resource Library
Wrap-Up and Summary
Wrap-Up and Summary
Back to course
[Please upgrade your browser to play this video content]
Video Transcription
So I know we're running short on time, I'll keep this really brief. One of the criticisms of the data that we currently have is that, as we mentioned, some patients are being excluded. A large group of patients that we care for, for intracranial hemorrhage, do require surgical intervention. So I think it's exciting that an XRS was started last October. So hopefully, we will soon have data so we can know how to better treat those patients. I don't need to reiterate this because it's already been discussed, but the quality of PCC data is limited, it's an off-label use, dosing's varied, and as has been discussed, a very weak trial design. I'm ultimately going to end on focusing on hematoma expansion. There's a lot of talk about what is a clinically significant outcome. And we did say time is going to be super important. We need longer-term outcomes. The natural disease course for intracranial hemorrhage goes beyond 30 days. Therefore, we might not know if there are any clinically or statistically significant differences in outcomes unless we follow these people further out to three or six months or beyond. But we do know that hematoma expansion is a powerful predictor of outcome. And I'm going to highlight this. It was shown actually by both of us. This is one of the studies that showed that the mean difference in hematoma expansion between index and alpha in PCCs was 4 mLs. And while that might seem like a nothing amount, we actually know that each single mL of hematoma expansion is related to a 5% increase of odds of death or dependence. So if we take that 4 mLs, that's actually 20% increase in odds of death or dependence. So I want to leave you with, would you rather be the person that doesn't have hematoma expansion with a 42% of functional dependence at 90 days, or the person that develops hematoma expansion and has a 13% chance of functional independence with a 97% chance of mortality? Thank you. All right. In the last two minutes here, I have brief slides on our wrap-up and summary. I do have to disclose that I do have grant funding from AstraZeneca. So like the debate of best female artist, Taylor Swift fan, so I used any opportunity to share a picture of her, the debate continues of indexa and four-factor PCC. So we're left with maybe more questions than answers. What is the most meaningful outcome in ICH reversal studies? Historically, we have looked at hematoma expansion, but maybe it's time we shift and look towards more patient-specific outcomes, such as mortality and modified Rankin score. Really what agent should be used for DOAC-related ICH reversal is still not answered. And which agent is safer and more cost-effective? So in summary, we currently lack head-to-head trial results. There are limitations to evidence support both agents, like Dr. Kaufman and Dr. Roney shared. We have a lack of standardized definitions and outcomes, including both efficacy and safety, different timeframes for thrombotic events, and different definitions for thrombotic events. And not all bleeds are created equal. The patients we care for at the bedside are different than those that are enrolled in our prospective trials. So next steps, Anexa I results are pending, as was discussed. This will be our first head-to-head prospective trial. Anexa RS is underway, looking at reversal for urgent surgery. As was discussed, code ICH has come out, so time to reversal is important. So we need to start thinking about how we're going to operationalize and get the agents in our automated PCSIS machines and get them to the bedside to the patient quicker. A new cost analysis should be done with the new cost of Anexa Alpha. And an individualized approach needs to occur. So we need to start looking at anti-TENA levels before reversal, confirming patients are on the agents, and use this individualized approach.
Video Summary
The transcript discusses the challenges and developments in treating intracranial hemorrhage, emphasizing the need for better data and individualized approaches. Current criticisms include limited PCC data and inconsistent trial designs. Hematoma expansion, a predictor of outcomes, indicates higher mortality and dependency risks per milliliter of expansion. Recent trials like Anexa I and RS aim to address gaps, focusing on urgent surgery and faster agent delivery. The debate continues between using Indexa and four-factor PCC for DOAC-related hemorrhage. Future steps include analyzing costs, improving outcome definitions, and tailoring treatments to individual anti-TENA levels.
Asset Caption
45-Minute Session | Pro/Con Debate: Flip It and Reverse It: ICH Management
Meta Tag
Content Type
Presentation
Membership Level
Professional
Membership Level
Select
Year
2024
Keywords
intracranial hemorrhage
hematoma expansion
PCC data
individualized treatment
DOAC-related hemorrhage
Society of Critical Care Medicine
500 Midway Drive
Mount Prospect,
IL 60056 USA
Phone: +1 847 827-6888
Fax: +1 847 439-7226
Email:
support@sccm.org
Contact Us
About SCCM
Newsroom
Advertising & Sponsorship
DONATE
MySCCM
LearnICU
Patients & Families
Surviving Sepsis Campaign
Critical Care Societies Collaborative
GET OUR NEWSLETTER
© Society of Critical Care Medicine. All rights reserved. |
Privacy Statement
|
Terms & Conditions
The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.
×
Please select your language
1
English