Management of apixaban-associated subdural hematoma: a case report on the use of factor eight inhibitor bypassing activity

Critical Care Medicine
Derrick R RinehartA Shaun Rowe

Abstract

We report a case of a patient receiving apixaban who developed a spontaneous subdural hematoma and declining mental status that improved after administration of a single dose of factor eight inhibitor bypassing activity. Case report. Comprehensive Stroke Center, Neurocritical Care Unit. A 76-year-old man presented to an outside facility with a chief complaint of headache and pain behind his right eye. A CT scan of his head revealed a subdural hematoma. The patient was transferred to our facility with worsening clinical status. After a confirmatory cranial CT scan revealed a worsening subdural hematoma with midline shift, a single dose of factor VIII inhibitor bypassing activity (25 U/kg) was administered. Coagulation tests following the administration of factor VIII inhibitor bypassing activity and a follow-up CT scan confirmed hemostasis. The patient was discharged home with no focal deficits. Factor VIII inhibitor bypassing activity may be a viable, nonspecific reversal agent for life-threatening bleeding associated with apixaban.

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Citations

Mar 5, 2016·Current Opinion in Anaesthesiology·Christian von HeymannMichael Sander
Apr 1, 2018·BMJ Case Reports·Eman AlayadAhmed Aloraidi
Feb 6, 2019·VASA. Zeitschrift für Gefässkrankheiten·Paul Gressenberger
Nov 23, 2016·Case Reports in Critical Care·Kenichi NittaKatsunori Mochizuki
Dec 28, 2017·Journal of Pharmacy Practice·Andrew C FaustTina Denetclaw
Jun 11, 2019·International Journal of Emergency Medicine·Maureane HoffmanJerrold H Levy

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