Intraoperative Off-Label Reversal of Apixaban by Andexanet Alfa while on VA-ECMO Immediately After Emergent Surgery for Acute Type A Aortic Dissection

Kainz, Matthias; Bsuchner, Paul; Schellongowski, Peter; Dworschak, Martin

doi:10.1053/j.jvca.2020.08.017

Cited by 14 publications

(8 citation statements)

References 9 publications

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“…Several andexanet alfa real‐world case reports and case series have included small numbers of procedural patients who were assessed for hemostasis up to 12 or 24 h after intervention 7,10–12,14–17,22–23 . However, robust and generalizable data are lacking.…”

Section: Discussionmentioning

confidence: 99%

“…6 Several andexanet alfa real-world case reports and case series have included small numbers of procedural patients who were assessed for hemostasis up to 12 or 24 h after intervention. 7,[10][11][12][14][15][16][17][22][23] However, robust and generalizable data are lacking. We found a comparable overall incidence of effective (good or excellent) hemostasis of 78.9% in patients who were able to be assessed compared to the 82% found in ANNEXA-4.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients suspected to undergo surgical procedures within 12 h of admission were excluded from ANNEXA‐4. Only case reports and small case series have described andexanet alfa utilization perioperatively 14–17 . Additional insight is needed to guide the management of FXa‐I‐mediated bleeding prior to invasive procedures in these vulnerable populations.…”

Section: Introductionmentioning

confidence: 99%

“…Only case reports and small case series have described andexanet alfa utilization perioperatively. 14 , 15 , 16 , 17 Additional insight is needed to guide the management of FXa‐I‐mediated bleeding prior to invasive procedures in these vulnerable populations. The purpose of this study was to describe the clinical outcomes of patients who received andexanet alfa for apixaban or rivaroxaban reversal up to 24 h before an invasive or surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

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Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures

et al. 2022

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Background: Outcomes following andexanet alfa reversal of factor Xa inhibitors in patients requiring urgent or emergent invasive procedures are lacking. This study aimed to describe efficacy and safety outcomes following andexanet alfa administration within 24 h of an invasive procedure.Methods: This single-center, observational, retrospective study included patients who received andexanet alfa within 24 h of an invasive or surgical procedure. The primary outcome was hemostatic efficacy graded as excellent, good, or poor using similar definitions to the ANNEXA-4 criteria. Secondary outcomes included hospital discharge disposition, intensive care unit (ICU) and hospital length of stay, 30-day mortality, 30-day thromboischemic event rates, and serum coagulation assay changes pre-and postreversal.Results: Forty-four patients met inclusion criteria; of these, 27 (62.8%) received apixaban and 16 (37.2%) were treated with rivaroxaban prior to admission. The indications for reversal were categorized as intracranial (n = 20 [45.5%]) or extracranial (n = 24 [54.5%]) sites. Majority of patients required emergent operative procedures (18 [40.9%]), followed by invasive device placement (10 [22.7%]) or arterial embolization (9 [20.5%]). Thirty-eight (86.4%) patients were able to be adequately graded for hemostatic efficacy. Overall, 30 (78.9%) patients achieved excellent or good hemostasis within 24 h after periprocedural administration of andexanet alfa ( 19[82.6%] apixaban vs. 11 [78.6%] rivaroxaban; 12 [80.0%] intracranial events vs. 18 [78.3%] extracranial events). Discharge disposition was most often to a short-or long-term care facilities (27 [61.4%]). Thirty-day mortality and thromboischemic complications occurred in 15 (34.1%) and 12 (27.3%) patients, respectively. Prothrombin time and | 781 BRADSHAW et al.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures

et al. 2022

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“…1,2 Several case reports and publications report use of andexanet in trauma and surgery patients, but data are extremely sparse. 6,12,13,[15][16][17][18][19][20][21][22][23] Andexanet pharmacology, safety, and monitoring require careful consideration and remain undescribed in surgery patients. We present an assessment of each of these factors in a unique surgical case where the andexanet infusion was prolonged.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Extended Duration Andexanet Alfa Infusion in a Surgical Trauma Patient

Philpott

Ernst

Makley

et al. 2022

Journal of Pharmacy Practice

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Background Andexanet alfa (andexanet) is the only FDA-approved medication for reversal of apixaban and rivaroxaban anticoagulation for life-threatening or uncontrolled bleeding. Infusion modifications may be required in surgical patients undergoing prolonged operative intervention but have not previously been described. Case Report A 78-year-old woman on rivaroxaban for atrial fibrillation was admitted to the trauma service for a mechanical fall, sustaining a T4 burst fracture with severe canal stenosis and spinal cord edema resulting in loss of strength and sensation in her legs. Clinically relevant rivaroxaban activity was verified with an elevated low molecular weight heparin anti-factor Xa assay, and laboratory confirmed coagulopathy was demonstrated by a prolonged prothrombin time, thromboelastography (TEG) R-time, and activated clotting time (ACT). The patient required urgent surgical intervention for spinal fixation. Given the expected prolonged duration of the procedure, standard dose andexanet was initiated with a prolonged infusion at half the standard rate during the operation. The procedure was successful and intraoperative TEGs demonstrated normalization of R-time and ACT throughout the procedure. The patient did not experience any complications postoperatively and successfully discharged to inpatient rehabilitation. Conclusion Modifications to the andexanet infusion may be required in surgical patients requiring rivaroxaban reversal for a prolonged procedure. Further data are needed to determine the optimal approach to infusion modification.

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Intraoperative Off-Label Reversal of Apixaban by Andexanet Alfa while on VA-ECMO Immediately After Emergent Surgery for Acute Type A Aortic Dissection

Cited by 14 publications

References 9 publications

Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures

Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures

Case Report: Extended Duration Andexanet Alfa Infusion in a Surgical Trauma Patient

Multiple drugs

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