Heparin Insensitivity and Thrombotic Risk Associated With Sequential Uses of Prothrombin Complex Concentrate and Andexanet Alfa for Apixaban Reversal During Acute Type A Aortic Dissection Repair: A Case Report-Reference-Cited by-同舟云学术

Heparin Insensitivity and Thrombotic Risk Associated With Sequential Uses of Prothrombin Complex Concentrate and Andexanet Alfa for Apixaban Reversal During Acute Type A Aortic Dissection Repair: A Case Report

Published:2022-11 Issue:11 Volume:16 Page:e01636
ISSN:2575-3126
Container-title:A&A Practice
language:en
Short-container-title:

Author:

Brenner Brian¹,Guerra Jessica²,Williams Campbell²,Littlewood Keith¹,Kern John¹³,Tanaka Kenichi⁴,McNeil John S.¹,Mangunta Venkat¹

Affiliation:

1. Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of Virginia, Charlottesville, Virginia

2. Division of Anesthesiology, Section of Cardiovascular Anesthesia, Saint Luke’s Mid America Heart Institute, University of Missouri–Kansas City, Kansas City, Missouri

3. Department of Surgery, Division of Cardiac Surgery, University of Virginia, Charlottesville, Virginia

4. Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma.

Abstract

The management of patients on direct oral anticoagulants (DOACs) who require emergent cardiac surgery is slowly evolving. The introduction of andexanet alfa, a novel antidote for apixaban and rivaroxaban, added a specific reversal agent to our armamentarium, but its safety and efficacy are still being investigated. We report 2 patients on DOAC treatment who required emergency cardiac surgery. Both received perioperative andexanet alfa together with prothrombin complex concentrate (PCC) at some time during 6 hours before operative management. Heparin resistance was noted in each instance, and pump thrombosis developed in 1 case.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine

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