In this episode, Rich and Pip discuss the ANNEXA-I trial (https://www.nejm.org/doi/full/10.1056/NEJMoa2313040). This was a randomised controlled trial of andexanet alfa, a decoy factor Xa molecule that is a reversal agent for oral factor Xa inhibitors. Patients were randomised to andexanet alfa or usual care. The primary outcome was haemostatic efficacy and andexanet alfa was shown to result in better control of haematoma expansion compared to usual care. However, there are many discussion points here not least the validity of the surrogate outcomes used in the trial.

Disclosure: Pip and Rich are named investigators on a grant from AstraZeneca to audit the use of reversal agents (including andexanet) across the UK. Pip has also received honoraria from AstraZeneca. To see our full list of financial disclosures, search for us on Who Pays This Doctor.

In the next episode, Pip and Rich will discuss ANNEXA-I with Dr Will Lester.

There is also a tiny mistake in the news section where Pip says that the infected blood inquiry report is 1200 pages long where in fact it is over 2500.

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