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Case Reports
. 2019 Oct 14;3(4):390-394.
doi: 10.5811/cpcem.2019.9.43650. eCollection 2019 Nov.

Difficult Intraoperative Heparinization Following Andexanet Alfa Administration

C James Watson  1 , Sara L Zettervall  2 , Matthew M Hall  1 , Michael Ganetsky  1
Affiliations
Case Reports

Difficult Intraoperative Heparinization Following Andexanet Alfa Administration

C James Watson et al. Clin Pract Cases Emerg Med. .

Abstract

Direct oral anticoagulants are now commonplace, and reversal agents are recently becoming available. Andexanet alfa (AnXa), approved by the United States Food and Drug Administration in 2018, is a novel decoy molecule that reverses factor Xa inhibitors in patients with major hemorrhage. We present a case of a 70-year-old man taking rivaroxaban with hemodynamic instability from a ruptured abdominal aortic aneurysm. He received AnXa prior to endovascular surgery, and intraoperatively he could not be heparinized for graft placement. Consideration should be given to the risks and benefits of AnXa administration in patients who require anticoagulation after hemorrhage has been controlled.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Figure 1
Figure 1
Timeline in operating room. Boxes represent administration of medications and blood products, as well as timing of the surgical procedure. The solid line represents the measured activated clotting time, which never became therapeutic (dashed line). ACT, activated clotting time; AnXa, Andexanet alfa; K, thousand; U, units; UFH, unfractionated heparin; pRBC, packed red blood cells; FFP, fresh frozen plasma; EVAR, endovascular repair.
See this image and copyright information in PMC

References

    1. Nutescu EA, Burnett A, Fanikos J, et al. Pharmacology of anticoagulants used in the treatment of venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):15–31. - PMC - PubMed
    1. Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–92. - PubMed
    1. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91. - PubMed
    1. The EINSTEIN–PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366(14):1287–97. - PubMed
    1. Agnelli G, Buller HR, Cohen A, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med. 2013;368(8):699–708. - PubMed

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