Key result
Administration of andexanet alfa for rivaroxaban reversal prior to emergent endovascular repair prevented adequate intraoperative heparinization, resulting in subtherapeutic activated clotting times and pelvic thrombosis.
Why the study?
Does andexanet alfa administration prevent adequate intraoperative heparinization in patients requiring emergent endovascular surgery?
Population
A 70-year-old man taking rivaroxaban with hemodynamic instability from a ruptured abdominal aortic aneurysm
Comparison
Andexanet alfa prior to endovascular surgery
Design
Case report
Authors
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May hinder intraoperative heparinization after andexanet alfa; leaves open optimal reversal strategies for emergent endovascular repair.
Case Report (n=1)
Does andexanet alfa administration prevent adequate intraoperative heparinization in patients requiring emergent endovascular surgery?
Administration of andexanet alfa for DOAC reversal may prevent subsequent therapeutic heparinization required for emergent endovascular procedures, increasing perioperative thrombotic risk.
Watson et al. (2019) conducted a case report in Ruptured abdominal aortic aneurysm (n=1). Andexanet alfa was evaluated on Activated clotting time (ACT) during intraoperative heparinization. Administration of andexanet alfa for rivaroxaban reversal prior to emergent endovascular repair prevented adequate intraoperative heparinization, resulting in subtherapeutic activated clotting times and pelvic thrombosis.