Therapeutic Plasma Exchange for Urgent Rivaroxaban Reversal

Texas Heart Institute Journal
Varun KumarWilson W Lam

Abstract

Direct oral anticoagulants, which include the factor Xa inhibitor rivaroxaban, have some advantages over vitamin K antagonists in regard to stroke prevention in patients with atrial fibrillation. However, no antidotes to reverse the effect of oral anticoagulants are commercially available, which can complicate treating patients in whom reversal is urgent. We faced this challenge in a kidney transplant candidate, a 65-year-old man with end-stage renal disease who had been taking rivaroxaban for paroxysmal atrial fibrillation. When a deceased-donor kidney became available, we needed to rapidly reduce the patient's bleeding risk, while minimizing the cold ischemic time of the donor kidney. Therefore, we decided to take an experimental approach and perform therapeutic plasma exchange. The patient's plasma anti-factor Xa level decreased from 0.4 IU/mL immediately before treatment to 0.21 IU/mL afterward, indicating that rivaroxaban had been actively removed from circulation. Waste fluid showed significant anti-Xa activity, indicating that the risk of rebound anticoagulation had been mitigated. The patient subsequently underwent successful kidney transplantation. To our knowledge, this is the first report of therapeutic plasma exchan...Continue Reading

References

Feb 9, 2010·Arteriosclerosis, Thrombosis, and Vascular Biology·Elisabeth PerzbornVolker Laux
Aug 13, 2011·The New England Journal of Medicine·Manesh R PatelUNKNOWN ROCKET AF Investigators
Oct 10, 2013·Current Opinion in Hematology·Sean Yates, Ravi Sarode
Sep 13, 2014·Journal of the American College of Cardiology·Adam CukerDavid A Garcia
Nov 13, 2015·The New England Journal of Medicine·Deborah M SiegalMark A Crowther
Oct 19, 2016·Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis·Sean G YatesRavi Sarode
Aug 31, 2016·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN ANNEXA-4 Investigators

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Citations

May 24, 2020·Neurocritical Care·Sherif Hanafy MahmoudTheresa Human
Jan 12, 2021·Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie·M-O TimsitD M Smadja

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