Utilization of thromboelastography and a low molecular weight heparin anti-Xa assay for guidance in apixaban reversal: A case report

The American Journal of Emergency Medicine
Brian W GilbertGeorge J Philip

Abstract

Reversal of oral factor Xa (FXa) inhibitors, such as apixaban, remains a controversial topic. However, the controversy goes beyond what reversal agent to utilize. Often times these patients present with an acute major bleed and are difficult to assess whether reversal is warranted or not. Furthermore, it is difficult to assess whether reversal was successful in a timely manner. A paucity of literature exists regarding the utilization of low molecular weight heparin (LMWH) anti-Xa assays and thromboelastography for identifying coagulopathies associated with oral FXa inhibitors. We report a case of apixaban induced coagulopathy utilizing thromboelastography and a LMWH anti-Xa assay as a guide for reversal.

Citations

Oct 5, 2020·The American Journal of Emergency Medicine·Veronica A BonderskiMegan A Rech
Jul 9, 2021·Journal of Thrombosis and Thrombolysis·Celia MortonKevin R Donahue

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