Managing Nonoperable Intracranial Bleeding Associated With Apixaban: A Series of 2 Cases
| Autor: | Mary Liu, Dang M Tran, Tina Harrach Denetclaw, Andrew C. Faust, Catherine Lo, Lyndsay Sheperd, Sophia Lai |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_mechanism_of_action Pyridones Intracranial Hemorrhages Factor Xa Inhibitor 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine medicine Humans Pharmacology (medical) 030212 general & internal medicine Disease management (health) Intensive care medicine Aged 80 and over business.industry Disease Management Prothrombin complex concentrate Pyrazoles Apixaban business Intracranial bleeding medicine.drug Factor Xa Inhibitors |
| Zdroj: | Journal of pharmacy practice. 31(1) |
| ISSN: | 1531-1937 |
| Popis: | Objective: To report 2 cases of nonoperable intracranial bleeding associated with apixaban managed by 3-factor prothrombin complex concentrate (PCC3). Case Summaries: Case 1 presented with a 1.3-cm left parieto-occipital hemorrhage and a thin subdural hematoma (SDH) on the left tentorium of the brain about 6 hours after his last dose of apixaban. Case 2 presented with a 4-mm left parafalcine SDH with time of most recent apixaban dose unknown. The patients received 24.9 to 25.5 U/kg of PCC3 with none to 1 U fresh frozen plasma (FFP) and demonstrated minimal or no progression in lesions measured by repeat computed tomography (CT) after treatment. One patient was discharged to a skilled nursing facility after 8 days; the other patient was discharged to home after 18 days. Discussion: Apixaban has no specific antidote. Current bleeding management strategies are based on expert opinion. The risks and benefits for differing strategies are unclear, and little clinical experience for managing apixaban-associated intracranial bleeding has been reported to date. These cases describe the clinical use of PCC3 to manage parieto-occipital and subdural hemorrhage associated with apixaban in events not requiring surgical intervention. Conclusion: In these 2 cases, 25 U/kg PCC3, with none to one unit FFP, ceased apixaban-associated intracranial bleeding without apparent thrombogenic complications. |
| Databáze: | OpenAIRE |
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