Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Oct 1;13(7):271-273.
doi: 10.1213/XAA.0000000000001052.

Andexanet Alfa for Urgent Reversal of Apixaban Before Aortic Surgery Requiring Cardiopulmonary Bypass: A Case Report

Devon Flaherty  1 , Jean M Connors  2 , Steve Singh  3 , Katelyn W Sylvester  4 , Jessica Rimsans  4 , Lauren Cornella  1
Affiliations
Case Reports

Andexanet Alfa for Urgent Reversal of Apixaban Before Aortic Surgery Requiring Cardiopulmonary Bypass: A Case Report

Devon Flaherty et al. A A Pract. .

Abstract

Andexanet alfa is a recombinant factor Xa decoy molecule capable of reversing direct and indirect factor Xa-inhibiting anticoagulants. We present an adult patient on apixaban for nonvalvular atrial fibrillation who required urgent reoperative aortic surgery for an aortic root pseudoaneurysm. Apixaban was reversed with andexanet alfa. A second dose of andexanet alfa was required before surgical incision for persistently elevated antifactor Xa levels. Intraoperative management required use of cardiopulmonary bypass (CPB). No major adverse cardiovascular, cerebrovascular, hemorrhagic, or thromboembolic events were observed.

PubMed Disclaimer

Comment in

References

    1. Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981–992.
    1. Lu G, DeGuzman FR, Hollenbach SJ, et al. A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa. Nat Med. 2013;19:446–451.
    1. Lu G, Lin J, Curnutte JT, Conley PB. Andexanet alfa, a universal antidote under development for factor Xa inhibitors, reverses rivaroxaban-induced inhibition of thrombin generation initiated by the intrinsic coagulation pathway independent of TFPI. Blood. 2016;128. Available at: http://www.bloodjournal.org/content/128/22/3831. Accessed November 19, 2018.
    1. Portola Pharmaceuticals. Andexxa (coagulation factor Xa (recombinant), inactivated-zhzo): US Prescribing Information. 2018. Available at: www.fda.gov/medwatch. Accessed December 12, 2018.
    1. Connolly SJ, Milling TJ, Eikelboom JW, et al. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med. 2016;375:1131–1141.

Publication types

LinkOut - more resources