Key result
Recombinant activated factor VII (60 μg/kg) improved hemostasis and prevented bleeding during emergent neurosurgery in a ticagrelor-treated patient, complicated by postoperative pulmonary embolism.
Why the study?
Does recombinant activated factor VII (rFVIIa) reverse ticagrelor-induced bleeding risk in a patient requiring emergent neurosurgery?
Case Report (n=1)
Does recombinant activated factor VII (rFVIIa) reverse ticagrelor-induced bleeding risk in a patient requiring emergent neurosurgery?
rFVIIa successfully reversed ticagrelor-induced platelet inhibition for emergent neurosurgery but resulted in a postoperative pulmonary embolism, highlighting the need for careful benefit-risk assessment.
Answers are grounded in this paper and cite their sources.
rFVIIa may bypass ticagrelor inhibition in neurosurgical bleeding; single case leaves open its efficacy and safety.
Management of ticagrelor-associated bleeding is challenging, especially in neurosurgery. Platelet transfusion is inefficient and no antidote is currently available. We report here the first case of recombinant activated factor VII (rFVIIa) use to bypass ticagrelor-induced platelet inhibition. A woman treated with ticagrelor and requiring emergent neurosurgery for an intracranial hematoma received preoperative high-dose platelet transfusion and 60 μg/kg rFVIIa. Laboratory monitoring demonstrated that platelet transfusion failed to reverse ticagrelor-induced platelet inhibition while rFVIIa improved hemostasis by shortening the thromboelastometric clotting time. Neurosurgery occurred without any bleeding event but the patient presented with a postoperative pulmonary embolism. In conclusion, rFVIIa may decrease ticagrelor-induced bleeding risk but careful assessment of the benefit-risk balance is warranted before using rFVIIa to reverse ticagrelor effects.
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Godiér et al. (2018) conducted a case report in Ticagrelor-associated bleeding risk during emergent neurosurgery (n=1). Recombinant activated factor VII (rFVIIa) was evaluated on Hemostasis and bleeding events. Recombinant activated factor VII (60 μg/kg) improved hemostasis and prevented bleeding during emergent neurosurgery in a ticagrelor-treated patient, complicated by postoperative pulmonary embolism.
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