Key result
Andexanet alfa successfully secured haemostasis in 3 patients requiring emergent surgery for type A aortic dissection, but may induce heparin resistance if given before cardiopulmonary bypass.
Why the study?
Does andexanet alfa secure haemostasis and is it safe in patients requiring emergent surgery for type A aortic dissection?
Case Report (n=3)
Does andexanet alfa secure haemostasis and is it safe in patients requiring emergent surgery for type A aortic dissection?
Andexanet alfa secures haemostasis in emergent type A aortic dissection repair but should be used with caution prior to cardiopulmonary bypass due to induced heparin resistance.
Caution against pre-CPB andexanet alfa due to heparin resistance risk; hypothesis-generating for reversal timing in emergent type A dissection.
Andexanet alfa was employed to reverse the anticoagulant effect of direct oral anticoagulants in 3 patients who required emergent surgery for repair of type A aortic dissection. Its use was instrumental in securing haemostasis. However, we caution against the administration of Andexanet alfa prior to cardiopulmonary bypass as it can induce heparin resistance and complicate the perioperative monitoring of anticoagulation during cardiopulmonary bypass.
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Al‐Attar et al. (2023) conducted a case report in Type A aortic dissection (n=3). Andexanet alfa was evaluated on Haemostasis. Andexanet alfa successfully secured haemostasis in 3 patients requiring emergent surgery for type A aortic dissection, but may induce heparin resistance if given before cardiopulmonary bypass.
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