Activated prothrombin complex concentrate to reverse the factor Xa inhibitor (apixaban) effect before emergency surgery: a case series

Journal of Medical Case Reports
Nina Haagenrud SchultzPål Andre Holme

Abstract

The lack of an antidote against factor Xa inhibitors in case of major bleeding or need for urgent surgery is a concern to clinicians. Guidelines on managing major bleeding in patients under anticoagulation with a factor Xa inhibitor suggest several hemostatic agents to reverse the effect, but there is no consensus regarding the choice of drug or appropriate dose. The ability of prothrombin complex concentrate, activated prothrombin complex concentrate, and recombinant factor VIIa to reverse the effect of factor Xa inhibitors has been evaluated in animal studies, in vitro studies, and healthy volunteers, but not yet in randomized clinical studies. We report a consecutive case series of patients under factor Xa inhibitor (apixaban) treatment who received activated prothrombin complex concentrate to reverse the anticoagulation effect before emergency cardiovascular surgery. Patient 1, a 63-year-old white man, was operated with replacement of the aortic valve; patient 2, a 65-year-old white man, underwent heart transplantation; patient 3, a 68-year-old white man, was operated for acute type A aortic dissection. They all received activated prothrombin complex concentrate 25 IU/kg immediately before surgery. In two of the cases, the ...Continue Reading

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Citations

Dec 7, 2018·Expert Opinion on Pharmacotherapy·Abdalla IbrahimBryan P Yan
Jan 3, 2019·Current Opinion in Anaesthesiology·Benedikt TremlBettina Schenk
Jul 22, 2020·Drugs·R Monroe Crawley, Rachel L Anderson
Mar 1, 2019·Current Opinion in Anaesthesiology·Benedikt TremlBettina Schenk
Sep 4, 2020·The Annals of Thoracic Surgery·Ashraf A SabeG Chad Hughes
Apr 27, 2021·Journal of Cardiothoracic and Vascular Anesthesia·Victor M NeiraKeir Stewart
Jun 2, 2021·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Nina Haagenrud SchultzPål Andre Holme
Aug 20, 2021·Journal of the American Society of Nephrology : JASN·An S De Vriese

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