Difficult Intraoperative Heparinization Following Andexanet Alfa Administration

Difficult Intraoperative Heparinization Following Andexanet Alfa Administration

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...

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Main Authors: C. James Watson, Sara L. Zettervall, Matthew M. Hall, Michael Ganetsky
Format: Article
Language:English
Published: eScholarship Publishing, University of California 2019-11-01
Series:Clinical Practice and Cases in Emergency Medicine
Online Access:https://escholarship.org/uc/item/7x43z9r3
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spelling doaj-409178bef0094e8289bfc6380e6edd5c2020-11-25T02:25:24ZengeScholarship Publishing, University of CaliforniaClinical Practice and Cases in Emergency Medicine2474-252X2019-11-013410.5811/cpcem.2019.9.43650cpcem-03-390Difficult Intraoperative Heparinization Following Andexanet Alfa AdministrationC. James Watson0Sara L. Zettervall1Matthew M. Hall2Michael Ganetsky3Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MassachusettsBeth Israel Deaconess Medical Center, Division of Vascular and Endovascular Surgery, Boston, MassachusettsBeth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MassachusettsBeth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MassachusettsDirect 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.https://escholarship.org/uc/item/7x43z9r3
collection DOAJ
language English
format Article
sources DOAJ
author C. James Watson
Sara L. Zettervall
Matthew M. Hall
Michael Ganetsky
spellingShingle C. James Watson
Sara L. Zettervall
Matthew M. Hall
Michael Ganetsky
Difficult Intraoperative Heparinization Following Andexanet Alfa Administration
Clinical Practice and Cases in Emergency Medicine
author_facet C. James Watson
Sara L. Zettervall
Matthew M. Hall
Michael Ganetsky
author_sort C. James Watson
title Difficult Intraoperative Heparinization Following Andexanet Alfa Administration
title_short Difficult Intraoperative Heparinization Following Andexanet Alfa Administration
title_full Difficult Intraoperative Heparinization Following Andexanet Alfa Administration
title_fullStr Difficult Intraoperative Heparinization Following Andexanet Alfa Administration
title_full_unstemmed Difficult Intraoperative Heparinization Following Andexanet Alfa Administration
title_sort difficult intraoperative heparinization following andexanet alfa administration
publisher eScholarship Publishing, University of California
series Clinical Practice and Cases in Emergency Medicine
issn 2474-252X
publishDate 2019-11-01
description 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.
url https://escholarship.org/uc/item/7x43z9r3
work_keys_str_mv AT cjameswatson difficultintraoperativeheparinizationfollowingandexanetalfaadministration
AT saralzettervall difficultintraoperativeheparinizationfollowingandexanetalfaadministration
AT matthewmhall difficultintraoperativeheparinizationfollowingandexanetalfaadministration
AT michaelganetsky difficultintraoperativeheparinizationfollowingandexanetalfaadministration
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