Concomitant andexanet alfa and 4 F-PCC for Factor Xa inhibitor associated intracranial hemorrhage

Orban, James E.; Ruckel, Cassidy; Harlan, Sarah

doi:10.1016/j.clineuro.2023.107908

Clinical Neurology and Neurosurgery

2023

DOI: 10.1016/j.clineuro.2023.107908

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Concomitant andexanet alfa and 4 F-PCC for Factor Xa inhibitor associated intracranial hemorrhage

James E. Orban,

Cassidy Ruckel,

Sarah Harlan

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2024

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Cited by 2 publications

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Andexanet Alfa: What We Have Learned from Clinical Trials and Real-World Data

Frol,

Oblak,

Šabovič

et al. 2024

CNS Drugs

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Andexanet Alfa: What We Have Learned from Clinical Trials and Real-World Data

Frol,

Oblak,

Šabovič

et al. 2024

CNS Drugs

View full text Add to dashboard Cite

Monitoring the efficiency of reversal on anti-Xa direct oral anticoagulants using point-of-care viscoelastic testing

Heubner,

Grottke,

Vicent

et al. 2024

Thrombosis J

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Bleeding events in patients receiving direct oral anticoagulation (DOAC) can be life-threatening even at therapeutic DOAC plasma concentrations, as anticoagulation impairs hemostasis and should therefore be identified immediately after hospital admission. The anticoagulatory effects of DOAC are typically not measurable in standard coagulation tests, such as PT or aPTT. Specific calibrated anti-FXa-tests allow specific drug monitoring, but they are too time-consuming for critical bleeding events and are commonly not available for 24 h/7 days in routine care. However, recent advances in point-of-care (POC) viscoelastic testing (VET) have shown a promising approach for rapid and quantitative detection of DOAC plasma concentrations using the Russell viper venom factor V activator (RVV for FXa-inhibitors) test or the ecarin clotting time (thrombin inhibitors). In acute bleeding situations, direct FXa inhibitors can be reversed by specific antidote andexanet alfa or hemostasis can be improved by prothrombin complex factor concentrates (PCCs). After reversal, confirmation of reversal efficacy is often requested, but no routine assays are currently available. Thus, the emergency management of bleeding DOAC patients is usually “blinded” with regard to reversal efficacy. POC VET laboratory assays might therefore also be helpful for measuring DOAC effects after reversal. We present a case series demonstrating the usefulness of RVV-clotting time post-DOAC reversal with andexanet alfa.

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Concomitant andexanet alfa and 4 F-PCC for Factor Xa inhibitor associated intracranial hemorrhage

Cited by 2 publications

References 19 publications

Andexanet Alfa: What We Have Learned from Clinical Trials and Real-World Data

Andexanet Alfa: What We Have Learned from Clinical Trials and Real-World Data

Monitoring the efficiency of reversal on anti-Xa direct oral anticoagulants using point-of-care viscoelastic testing

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