John is a 72-year-old male veteran with atrial fibrillation on apixaban 5 mg twice daily who presents to the emergency department with an acute intracerebral hemorrhage. His medical history includes hypertension and prior ischemic stroke. The neurology team requests pharmacist input on reversal agent options. Current medications include apixaban and lisinopril 20 mg daily. He has no known allergies and is insured through the VA system.

Based on recent evidence comparing andexanet alfa (AA) and four-factor prothrombin complex concentrate (4F-PCC) for factor Xa inhibitor-related intracerebral hemorrhage, which of the following is the most appropriate pharmacist recommendation regarding reversal agent selection for John?

Mary is a 68-year-old female veteran on rivaroxaban for deep vein thrombosis who experienced an intracerebral hemorrhage and received andexanet alfa in the emergency department. She has a history of coronary artery disease and type 2 diabetes. After stabilization, she is transferred to the inpatient unit. The pharmacist is asked to provide counseling and monitoring recommendations.

What is the most critical monitoring and counseling point the pharmacist should emphasize for Mary after administration of andexanet alfa?

David is a 75-year-old male veteran with atrial fibrillation on apixaban who presents with a spontaneous intracerebral hemorrhage. He has a history of prior venous thromboembolism and myocardial infarction. The clinical team is debating between andexanet alfa and 4F-PCC for reversal. The pharmacist is consulted to provide a risk-benefit analysis.

Considering David’s history and recent evidence, which factor should most influence the pharmacist’s recommendation for reversal agent choice?