Impact of elevated direct factor Xa inhibitor plasma levels on perioperative blood loss in patients undergoing urgent surgery.

Autor: Mair A; Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland., Sahli SD; Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland., Studt JD; Department of Medical Oncology and Hematology, University of Zurich and University Hospital Zurich, Zurich, Switzerland., Braun J; Departments of Biostatistics and Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Lunkiewicz J; Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland., Spahn DR; Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland., Kaserer A; Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2024 Nov; Vol. 64 (11), pp. 2114-2123. Date of Electronic Publication: 2024 Sep 25.
DOI: 10.1111/trf.18021
Abstrakt: Introduction: Data on the perioperative bleeding risk associated with elevated plasma levels of direct factor Xa inhibitors (FXa inhibitors) are limited. This study examines perioperative red blood cell (RBC) loss in patients undergoing urgent surgery with a residual FXa inhibitor level exceeding 100 mcg/L and without preoperative FXa inhibitor reversal.
Methods: This retrospective analysis includes data from 32 patients who underwent urgent noncardiac surgery between 2018 and 2022. This study aims to analyze perioperative RBC loss in patients undergoing urgent surgery with a residual FXa inhibitor level exceeding 100 mcg/L and without preoperative FXa inhibitor antidote-based reversal or unspecific treatment with 4-factor prothrombin complex concentrate (PCC). All patients were managed using a watch-and-wait strategy.
Results: The last determination of FXa inhibitor plasma concentration prior to surgery showed a median of 245 mcg/L (IQR 144-345), with a median time interval of 3.8 h (IQR 2.4-7.2) before incision. Median RBC loss during surgery was 49 mL (IQR 0-253), 189 mL (IQR 104-217) until POD1 and 254 mL (IQR 58-265) until POD3. Only one patient required intraoperative treatment with 4-factor-PCC and none required reversal with andexanet alfa. Linear regression models found no significant influence of FXa inhibitor plasma levels on intraoperative RBC loss. Rivaroxaban was associated with higher RBC loss until postoperative Day 1 compared with apixaban. No thromboembolic events were observed.
Conclusion: Despite markedly elevated plasma concentrations of residual direct FXa inhibitors, perioperative RBC loss was limited in patients undergoing urgent noncardiac surgery. The intraoperative watch-and-wait strategy with selective intraoperative FXa inhibitor reversal or treatment only when required appears to be an appropriate approach.
(© 2024 The Author(s). Transfusion published by Wiley Periodicals LLC on behalf of AABB.)
Databáze: MEDLINE
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