Emergency neurosurgical care in patients treated with apixaban: report of 2 cases

Beynon, Christopher; Potzy, Anna; Unterberg, Andreas; Sakowitz, Oliver W.

doi:10.1016/j.ajem.2014.12.017

Cited by 10 publications

(7 citation statements)

References 10 publications

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“…Previously, we have reported on the successful management of intracranial haemorrhage in apixabantreated patients with PCC administration prior to neurosurgical intervention. [29] In the present series, PCC administration was associated with 30-day mortality, most likely because of a more frequent use in severe cases, especially if neurosurgical intervention was necessary. We used PCC with a median dosage of 2000 I.E.…”

Section: Discussionmentioning

confidence: 93%

Intracranial haemorrhage in patients treated with direct oral anticoagulants

Beynon

Sakowitz

Störzinger

et al. 2015

Thrombosis Research

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Section: Discussionmentioning

confidence: 93%

Intracranial haemorrhage in patients treated with direct oral anticoagulants

Beynon

Sakowitz

Störzinger

et al. 2015

Thrombosis Research

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“…Orally administered activated charcoal reduces the absorption of apixaban, thereby lowering the apixaban plasma concentration, and may be useful when more rapid removal of apixaban is desired . However, there are a growing number of case reports and guidelines suggesting that PCCs may have a role in the more acute management of patients experiencing bleeding while being treated with a direct FXa inhibitor. Further research is needed to address unanswered questions left by this, and other healthy subject studies, to determine exactly what role PCCs may have, especially as work on specific FXa inhibitor reversal agents progresses.…”

Section: Discussionmentioning

confidence: 99%

Reversal of apixaban anticoagulation by four‐factor prothrombin complex concentrates in healthy subjects: a randomized three‐period crossover study

Wang

Perlstein

Wang

et al. 2017

Journal of Thrombosis and Haemostasis

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Background Currently, there is no approved reversal agent for direct activated factor Xa (FXa) inhibitors; however, several agents are under investigation, including prothrombin complex concentrates (PCCs). Objective This open-label, randomized, placebo-controlled, three-period crossover study assessed the effect of two four-factor PCCs on apixaban pharmacodynamics and pharmacokinetics in 15 healthy subjects. Methods Subjects received apixaban 10 mg twice daily for 3 days. On day 4, 3 h after apixaban, subjects received a 30-min infusion of 50 IU kg Cofact, Beriplex P/N (Beriplex), or saline. Change in endogenous thrombin potential (ETP), measured with a thrombin generation assay (TGA), was the primary endpoint. Secondary endpoints included changes in other TGA parameters, prothrombin time (PT), International Normalized Ratio (INR), activated partial thromboplastin time, anti-FXa activity, apixaban pharmacokinetics, and safety. Results Apixaban-related changes in ETP and several other pharmacodynamic measures occurred following apixaban administration. Both PCCs reversed apixaban's effect on ETP; the differences in adjusted mean change from pre-PCC baseline to end of infusion were 425 nm min (95% confidence interval [CI] 219.8-630.7 nm min; P < 0.001) for Cofact, and 91 nm min (95% CI - 31.3 to 212.4 nm min; P > 0.05) for Beriplex. Both PCCs returned ETP to pre-apixaban baseline levels 4 h after PCC infusion, versus 45 h for placebo. For both PCCs, mean ETP peaked 21 h after PCC initiation, and then slowly decreased over the following 48 h. Both PCCs reversed apixaban's effect on TGA peak height, PT, and INR. Apixaban pharmacokinetic and anti-FXa profiles were consistent across treatments. Conclusions Cofact and Beriplex reversed apixaban's steady-state effects on several coagulation assessments.

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“…There have also been a few case reports of patients on factor Xa inhibitors (either apixaban or rivaroxaban) being treated with prothrombin complex concentrate prior to undergoing a surgical procedure. 102–104 Overall, administration of prothrombin complex concentrate was associated with successful completion of surgery and no bleeding complications were reported. 102–104…”

Section: Resultsmentioning

confidence: 95%

“…102–104 Overall, administration of prothrombin complex concentrate was associated with successful completion of surgery and no bleeding complications were reported. 102–104…”

Section: Resultsmentioning

confidence: 95%

Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non–vitamin K Anticoagulant Reversal

et al. 2018

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Vitamin K antagonist therapy is associated with an increased bleeding risk, and clinicians often reverse anticoagulation in patients who require emergency surgical procedures. Current guidelines for rapid anticoagulation reversal for emergency surgery recommend four-factor prothrombin complex concentrate and vitamin K coadministration. The authors reviewed the current evidence on prothrombin complex concentrate treatment for vitamin K antagonist reversal in the perioperative setting, focusing on comparative studies and in the context of intracranial hemorrhage and cardiac surgery. The authors searched Cochrane Library and PubMed between January 2008 and December 2017 and retrieved 423 English-language papers, which they then screened for relevance to the perioperative setting; they identified 36 papers to include in this review. Prothrombin complex concentrate therapy was consistently shown to reduce international normalized ratio rapidly and control bleeding effectively. In comparative studies with plasma, prothrombin complex concentrate use was associated with a greater proportion of patients achieving target international normalized ratios rapidly, with improved hemostasis. No differences in thromboembolic event rates were seen between prothrombin complex concentrate and plasma, with prothrombin complex concentrate also demonstrating a lower risk of fluid overload events. Overall, the studies the authors reviewed support current recommendations favoring prothrombin complex concentrate therapy in patients requiring vitamin K antagonist reversal before emergency surgery.

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Emergency neurosurgical care in patients treated with apixaban: report of 2 cases

Cited by 10 publications

References 10 publications

Intracranial haemorrhage in patients treated with direct oral anticoagulants

Intracranial haemorrhage in patients treated with direct oral anticoagulants

Reversal of apixaban anticoagulation by four‐factor prothrombin complex concentrates in healthy subjects: a randomized three‐period crossover study

Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non–vitamin K Anticoagulant Reversal

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