Difficult Intraoperative Heparinization Following Andexanet Alfa Administration

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" Difficult Intraoperative Heparinization Following Andexanet Alfa Administration "
Watson, C. James; Zettervall, Sara L.; Hall, Matthew M.; Ganetsky, Michael

Document Type	:	AL
Record Number	:	928143
Doc. No	:	LA7x43z9r3
Language of Document	:	English
Main Entry	:	Watson, C. James; Zettervall, Sara L.; Hall, Matthew M.; Ganetsky, Michael
Title & Author	:	Difficult Intraoperative Heparinization Following Andexanet Alfa Administration [Article]\ Watson, C. James; Zettervall, Sara L.; Hall, Matthew M.; Ganetsky, Michael
Title of Periodical	:	Clinical Practice and Cases in Emergency Medicine
Volume/ Issue Number	:	3/4
Date	:	2019
Abstract	:	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.