Andexanet alfa

Again, please get in touch with me if I'm barking at the wrong tree, but the idea of a misuse index.

So many of you will know that my sort of high horse has been anticoagulation reversal and Andexanet and looking at some of the data for Andexanet locally and around the country, like this drug doesn't get used properly.

so it's quite hard to give it's a infusion it's a bolus than an infusion and often the the different doses are mixed up sometimes the bolus is given before with the infusion dose as one off one off bolus and then there's massive delays between the bolus and the infusion which are meant to be given straight after each other and that massively colors how how effective therapies are in the real world and the potential for harm and and obviously this is quite this is quite involved it's quite difficult so you know with an intervention like this done in a trial center how does that extrapolate to a non-trial center with staff who are less familiar where the protocols aren't as good where the selection isn't quite so good where you get mission creep and you start doing it on patients who don't really need it and the aftercare isn't quite so good i just think this like this kind of intervention where it's pretty heavy duty we really need to try and factor in when we think about it from a nhs point of view definitely from a pan healthcare system point of view how easy it can go wrong And I don't think there's much work on how well that is defined or how you define that risk and whether that's factored into funding at all.

And that's where we're quite passionate about real world evidence and the importance of larger scale audit and really looking at how real world outcomes compare with trials.