Emergent external ventricular drain placement in patients with factor Xa inhibitor-associated intracerebral hemorrhage after reversal with andexanet alfa.

Autor: Ammar AA; Department of Pharmacy, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA; Department of Pharmacy, New York Presbyterian/Weill Cornell, 525 East 68th Street, New York, NY 10065, USA. Electronic address: SVF9004@NYP.ORG., Elsamadicy AA; Departments of Neurosurgery, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Ammar MA; Department of Pharmacy, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA., Reeves BC; Departments of Neurosurgery, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Koo AB; Departments of Neurosurgery, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Falcone GJ; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Hwang DY; Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, Chapel Hill, NC 27599, USA., Petersen N; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Kim JA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Beekman R; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Prust M; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Magid-Bernstein J; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Acosta JN; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Herbert R; Departments of Neurosurgery, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Sheth KN; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Matouk CC; Departments of Neurosurgery, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA., Gilmore EJ; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA.
Jazyk: angličtina
Zdroj: Clinical neurology and neurosurgery [Clin Neurol Neurosurg] 2023 Mar; Vol. 226, pp. 107621. Date of Electronic Publication: 2023 Feb 09.
DOI: 10.1016/j.clineuro.2023.107621
Abstrakt: Background: Andexanet alfa (AA), a factor Xa-inhibitor (FXi) reversal agent, is given as a bolus followed by a 2-hour infusion. This long administration time can delay EVD placement in intracerebral hemorrhage (ICH) patients. We sought to evaluate the safety of EVD placement immediately post-AA bolus compared to post-AA infusion.
Methods: We conducted a retrospective study that included adult patients admitted with FXi-associated ICH who received AA and underwent EVD placement The primary outcome was the occurrence of a new hemorrhage (tract, extra-axial, or intraventricular hemorrhage). Secondary outcomes included mortality, intensive care unit and hospital length of stay, and discharge modified Rankin Score. The primary safety outcome was documented thrombotic events.
Results: Twelve patients with FXi related ICH were included (EVD placement post-AA bolus, N = 8; EVD placement post-AA infusion, N = 4). Each arm included one patient with bilateral EVD placed. There was no difference in the incidence of new hemorrhages, with one post-AA bolus patient had small, focal, nonoperative extra-axial hemorrhage. Morbidity and mortality were higher in post-AA infusion patients (mRS, post-AA bolus, 4 [4-6] vs. post-AA infusion 6 [5,6], p = 0.24 and post-AA bolus, 3 (37.5 %) vs. post-AA infusion, 3 (75 %), p = 0.54, respectively). One patient in the post-AA bolus group had thrombotic event. There was no difference in hospital LOS (post-AA bolus, 19 days [12-26] vs. post-AA infusion, 14 days [9-22], p = 0.55) and ICU LOS (post-AA bolus, 10 days [6-13] vs. post-AA infusion, 11 days [5-21], p = 0.86).
Conclusion: We report no differences in the incidence of tract hemorrhage, extra-axial hemorrhage, or intraventricular hemorrhage post-AA bolus versus post-AA infusion. Larger prospective studies to validate these results are warranted.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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