Why the study?
With more patients taking new oral anticoagulants, andexanet alfa is used to reverse factor Xa inhibitors in intracranial hemorrhage, but its association with heparin resistance remains underrecognized among stroke clinicians.
Does andexanet alfa cause heparin resistance in patients with hemorrhagic stroke?
Does andexanet alfa cause heparin resistance in patients with hemorrhagic stroke?
Highlights a critical, underrecognized safety issue where andexanet alfa causes heparin resistance, posing severe risks for stroke patients requiring periprocedural heparin.
Answers are grounded in this paper and cite their sources.
May warrant heparin avoidance with andexanet alfa; leaves open prospective validation in hemorrhagic stroke.
BACKGROUND: With a growing number of patients on new oral anticoagulants, interest in reversal agents is rising. Andexanet alfa is used for reversal of factor Xa inhibitors in intracranial hemorrhage. METHODS: We provide a brief review on andexanet-alfa-associated heparin resistance and discuss potentially critical situations from different clinical perspectives. RESULTS: Case reports point out that andexanet alfa can cause unresponsiveness to heparin, leading to catastrophic events. As a result, regulatory bodies have issued warning notices to avoid heparinization parallel to the use of andexanet alfa. CONCLUSIONS: Although well known to hematologists, the phenomenon is underrecognized among stroke clinicians. However, patients with intracranial hemorrhage frequently undergo endovascular or surgical interventions that require periprocedural administration of heparin.
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Müther et al. (2022) studied this question.
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