Evaluation of oral factor Xa inhibitor‐associated extracranial bleeding reversal with andexanet alfa
| Autor: | Russel J. Roberts, George C. Velmahos, Leon Naar, Martin G. Rosenthal, Haytham M.A. Kaafarani, Charlie J. Nederpelt, Megan E Barra, David R. King, Katelyn W. Sylvester |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_mechanism_of_action Deep vein Factor Xa Inhibitor factor Xa inhibitors Hemorrhage PRT064445 030204 cardiovascular system & hematology Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine Epidemiology medicine Humans Aged Retrospective Studies business.industry HAEMOSTASIS Incidence (epidemiology) Anticoagulants Original Articles Hematology medicine.disease Thrombosis Recombinant Proteins Pulmonary embolism medicine.anatomical_structure Hemostasis Factor Xa hemostasis treatment outcome Original Article Female business Andexanet alfa medicine.drug |
| Zdroj: | Journal of Thrombosis and Haemostasis |
| ISSN: | 1538-7836 |
| Popis: | Introduction A reversal agent for factor Xa (FXa) inhibitors, andexanet alfa, was Food and Drug Administration approved without extensive study of clinical effectiveness, due to an overwhelming demand for FXa inhibitor reversal. In this study, we aimed to describe patient selection, clinical effectiveness, and safety of FXa inhibitor reversal with andexanet alfa in patients presenting with extracranial bleeding. Methods Consecutive patients who received andexanet alfa for reversal of FXa inhibitor‐associated extracranial hemorrhage were identified. The primary outcome of interest was hemostatic efficacy, assessed using the Sarode et al criteria. Secondary outcomes of interest included incidence of thrombotic episodes post‐reversal until discharge and in‐hospital mortality. Results Twenty‐one patients met the inclusion criteria (61.9% male, mean age: 73 years). Anticoagulation reversal with andexanet alfa was deemed effective (excellent [n = 3], good [n = 7]) in 10 (47.6%) patients, and poor in 11 patients (52.4%). Eight (38.1%) patients died, of which three were surgically managed, with all causes of death attributed to hemorrhage. Six ischemic complications occurred in four patients (19.0%); ischemic stroke (n = 2], pulmonary embolism (n = 1), deep vein thrombosis (n = 1), liver ischemia (n = 1), and bowel ischemia (n = 1). Conclusion We report poor overall outcomes, a low rate of hemostatic effectiveness, and a high rate of ischemic complications and mortality in this retrospective analysis of oral FXa inhibitor reversal with andexanet alfa for extracranial bleeds. More rigorous epidemiological, and ideally randomized studies, are needed to determine the role of andexanet alfa for FXa inhibitor‐associated bleeding for extracranial hemorrhages, where large variation in severity and presentation exists. |
| Databáze: | OpenAIRE |
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