Emergent Reversal of Direct Oral Anticoagulants Permitting Neurosurgical Intervention for Nonhemorrhagic Pathology
| Autor: | Brandon A. Sherrod, Sarah T. Menacho, Marcus D. Mazur, Andrea A. Brock, Holly K. Ledyard, Chad Condie |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Ventriculostomy
medicine.medical_specialty Rivaroxaban business.industry medicine.medical_treatment Atrial fibrillation medicine.disease Prothrombin complex concentrate 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Medicine Surgery Neurology (clinical) Neurosurgery Dosing business Intensive care medicine Stroke 030217 neurology & neurosurgery medicine.drug Andexanet alfa |
| Zdroj: | World Neurosurgery. 135:38-41 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2019.11.162 |
| Popis: | Background Direct oral anticoagulants (DOACs) are becoming the medication of choice for the management of venous thromboembolism and stroke prevention in atrial fibrillation because of simplified dosing, a more predictive pharmacokinetic profile, and better clinical outcomes when compared with traditional vitamin K antagonists. Recently, reversal agents for DOACs have been approved by the U.S. Food and Drug Administration for use in managing life-threatening or uncontrolled bleeding; however, for acute nonhemorrhagic conditions requiring surgical intervention, such as acute hydrocephalus requiring ventriculostomy, there is little evidence to help guide appropriate management for patients on DOACs. Case Description We report the use of andexanet alfa to counteract rivaroxaban treatment in a 28-year-old woman who developed herniation syndrome and acute hydrocephalus from a cerebellar tumor. Conclusions We describe how appropriate timing of administration of the DOAC reversal agent may permit urgent neurosurgical intervention. |
| Databáze: | OpenAIRE |
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