Case Studies in Optimal Management of Anti-FXa-DOAC-Associated Intracranial Hemorrhage: Specific vs Nonspecific Anticoagulant Reversal

Program Dates: November 21st, 2022 - November 20th, 2023
Credits: 1.50 AMA PRA Category 1 Credits™

Case Studies in Optimal Management of Anti-FXa-DOAC-Associated Intracranial Hemorrhage: Specific vs Nonspecific Anticoagulant Reversal

Program Overview

This CME program is derived from content presented at the 8th European Stroke Organization Conference (ESOC 2022). This educational activity, chaired by Dr. Thorsten Steiner, will review optimal management strategies of patients with anti-FXa-DOAC-associate Intracranial Hemorrhage (ICH). The worldwide utilization of DOACs for a number of different indications has continuously increased over the past decade, and while the anti-FXa DOACS are associated with a significantly lower risk of ICH than warfarin, the risk remains ~0.05% in clinical trials and up to 2% in some real-world data sets. There is a pressing need for a consistent and streamlined response to these sometimes-devastating bleeding events. Join our expert faculty in a case-based discussion of management of anti-FXa-associated ICH and the evidence basis for specific vs nonspecific anticoagulation reversal strategies.


I. Welcome and Introductions – Thorsten Steiner, MD, PhD

II. Factor Xa as Therapeutic Target and as a Contributor to ICH – Thorsten Steiner, MD, PhD

III. Interactive Case Studies: The Importance of Rapid Clinical Decision Making in Patients with Anti-FXa-DOAC-Associated ICH

a. Specific Reversal vs Nonspecific Factor Repletion – Thorsten Steiner, MD, PhD

b. Whom to Treat – Adrian Parry-Jones, BSc, MBChB, PhD

c. Reversal Considerations in the Patient with Large ICH and Those Requiring Surgery- Michiel Coppens, MD, PhD

IV. Conclusions and Summary – Faculty Panel


Thorsten Steiner, MD, PhD
Neurologische Klinik, Klinikum Frankfurt Höchst
Neurologische Klinik, Heidelberg University Hospital
Department of Clinical Medicine Copenhagen University
Copenhagen, Denmark


Michiel Coppens, MD, PhD
Internist Vascular Medicine
Amsterdam University Medical Centers
Amsterdam, The Netherlands

Adrian Parry-Jones, BSc, MBChB, PhD
Consultant Vascular Neurologist
Manchester Centre for Clinical Neurosciences
Salford Royal NHS Foundation
Salford,United Kingdom

Disclosures of Relevant Financial Relationships

It is the policy of AcademicCME that all faculty, instructors, and planners disclose relevant financial relationships with ineligible companies. Any relevant financial relationships related to this activity have been mitigated.

Planners and faculty have no relevant financial relationships with ineligible companies for this activity, with the exception of the following:

Faculty Relationship Identified With:
Thorsten Steiner, MD, PhD Consultant/Advisor: AstraZeneca Pharmaceuticals; Bayer AG; Boehringer Ingelheim International GmbH; Bristol-Myers Squibb-Pfizer Alliance

Presenter: streamedUP

Michiel Coppens, MD, PhD Consultant/Advisor: Pfizer Inc.; Swedish Orphan Biovitrum AB; Viatris Inc.

Grant/Research Support: Anthos Therapeutics; AstraZeneca Pharmaceuticals; Bayer AG; CSL; Daiichi Sankyo Company, Limited; F. Hoffman-La Roche Ltd; Sanquin Blood Supply

Adrian Parry-Jones, BSc, MBChB, PhD Consultant/Advisor: AstraZeneca Pharmaceuticals; Op2Lysis

Planners and Peer Reviewers

Timothy Hayes, MD, PhD; Kim Cheramie, MSN, RN-BC; Chelsey Benedek and Nicole McMenamin hereby state that they or their spouse/life partner do not have any relevant financial relationships to products or devices with any commercial interests related to the content of this activity of any amount during the past 12 months.

Accreditation Statement

In support of improving patient care, AcademicCME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credit Designation Statements

AcademicCME designates this enduring material for a maximum of 1.25 AMA PRA Category 1 CreditsTM.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Financial Support

This activity has been supported by an independent educational grant from AstraZeneca Pharmaceuticals.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. AcademicCME and AstraZeneca Pharmaceuticals do not recommend the use of any agent outside of the labeled indications.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Method of Participation

In order to claim credit, participants must complete the following:

  1. Read the learning objectives, accreditation information and faculty disclosures at the beginning of this activity.
    2. Complete the Pre-Activity Questions
    3. Read or Review the activity content.
    4. Complete the Post-Activity Test Questions and Evaluation.
    5. Learners who receive a grade of 60% or better on the Post-Activity Test Questions andcomplete the Evaluation will receive appropriate credit as indicated (CME, CNE, and/or CPE credit).
  • CPE credit will be posted to the learner’s CPE Monitor profile within 60 days of completion.
  • CME and CNE credit will be issued appropriate certificate of completion.
  • Others may request a “certificate of completion”.
  1. Learners should claim only the credit commensurate with the extent of their participation in the activity.

CE Inquiries/Special Needs

For all CE inquiries or special needs, please contact [email protected].


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