Utilization of thromboelastography and a low molecular weight heparin anti-Xa assay for guidance in apixaban reversal: A case report

Gilbert, Brian W.; Adams, Tori; Reynolds, Tessa R.; Moran, David A.; Philip, George

doi:10.1016/j.ajem.2019.158369

Cited by 5 publications

(1 citation statement)

References 6 publications

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“…3 The use of oral FXa inhibitor-specific anti-Xa levels, low-molecular-weight heparin (LMWH) calibrated anti-Xa levels, and rapid thromboelastography (rTEG) have been used to guide the need for and to assess the efficacy of reversal of FXa inhibitors in patients with normal renal function. 4,5 However, supporting evidence is again lacking in patients with CKD. We report a case in which LMWH anti-Xa levels were used to guide reversal of apixaban by 4-factor prothrombin complex concentrate (4-PCC) in a patient with ESRD on hemodialysis (HD).…”

Section: Introductionmentioning

confidence: 99%

Low-Molecular-Weight Heparin Anti-Xa Guided Reversal of Apixaban With Prothrombin Complex Concentrate in a Patient on Hemodialysis

Brummett

Dingman

Philip

et al. 2021

Journal of Pharmacy Practice

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The growing use of oral factor Xa (FXa) inhibitors in patients with chronic kidney disease (CKD), particularly the recent increased use of apixaban in patients with end-stage renal disease (ESRD), has created a new dilemma in the already controversial topic of oral FXa inhibitor reversal. With the limited availability of anti-Xa levels specific to oral FXa inhibitors and even scarcer availability of reversal data for patients on these agents with ESRD, ensuring adequate reversal is currently often solely guided by repeat imaging and changes in clinical status. Low molecular weight heparin (LMWH) anti-Xa levels have been used as a more commonly accessible test to guide the need for and efficacy of reversal of oral FXa inhibitors in patients with normal renal function. However, evidence supporting this technique is again lacking in patients with renal dysfunction. This case report focuses on the use of LMWH anti-Xa levels to guide reversal of apixaban in a patient with ESRD on hemodialysis and correlation of those levels to the patient’s clinical status.

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Section: Introductionmentioning

confidence: 99%