430: Door-to-Treatment Time of Anticoagulant-Associated Spontaneous Ich

Introduction: Anticoagulant associated intracerebral hemorrhage (ICH) is a serious condition with recommendations to administer reversal within 60 minutes. This medication use evaluation assessed time to treatment with andexanet alfa (AA) or 4-factor prothrombin complex concentrate (PCCs) in patients presenting with spontaneous ICH. Methods: Adults receiving AA or 4-factor PCCs at a comprehensive stroke center for anticoagulant associated spontaneous ICH were included. Exclusion criteria included transfers from outside facilities, administration after hospital day 1, pregnancy or incarceration. The primary outcome was time to administration of reversal agent. Secondary outcomes were a comparison of time to treatment with either AA or PCCs, comparison of compounding times, time to head computed tomography (CT), comparison of direct oral anticoagulant (DOAC) versus warfarin, and impact of clinical pharmacist involvement. Results: A total of 62 patients (51 AA; 11 PCCs) were included. The median time to treatment was 90 (IQR 59-145) minutes with 16 patients (25.8%) treated within 60 minutes. Time to head CT was 7 (IQR 0-30) minutes and drug compounding time was 32.5 (IQR 21-40) minutes. When comparing AA and PCCs there was no difference in time to treatment (88 57-135 vs 115 52-166 minutes p=0.38). PCCs demonstrated a faster drug compounding time (24 7-37 vs 33 24-41 minutes p=0.04). There was no statistical difference between warfarin and DOAC time to treatment (67 40-123 vs 90 [65.8-146 minutes p=0.22). 46 patients had clinical pharmacist involvement, and these patients received treatment faster than those without pharmacist involvement (84 54.3-131 vs. 107.5 87.3-160.5 minutes p=0.07). Pharmacist involvement had no impact on drug compounding time (32 20.8-37.8 vs 33 22.5-56.5 minutes p=0.4). Conclusions: Time to treatment of anticoagulant associated ICH was frequently not within the 60-minute recommendation indicating the need for further initiative to improve door to treatment times. Utilizing clinical pharmacists on the interdisciplinary team might improve door to treatment times in anticoagulant associated ICH.