Visualized Efficacy of Andexanet Alfa in an Elderly Trauma Patient with an Unstable Pelvic Fracture

Key Words: trauma, andexanet alfa, hemorrhagic shockAn 89-year-old man taking rivaroxaban, an oral, direct Factor Xa inhibitor, for arterial fibrillation was referred to our department with hemorrhagic shock after falling accidentally.Pelvic images revealed a pelvic fracture classified as LC-III according to the Young-Burgess classification with active bleeding in the pelvic muscles (Figure 1).Therefore, an intravenous injection of 400 mg was administered at a rate of 30 mg/ min, followed by an infusion of 4 mg/min of andexnet alfa for 2 h.After 15 min of starting injection, emergency angiography revealed the disappearance of bleeding (Figure 2).Embolization was discontinued, and 1,960 mL of erythrocytes and 1,680 mL of fresh frozen plasma were administered within 24 h.Although andexanet alfa can reduce antifactor Xa activity during administration, its role in trauma patients has not been sufficiently studied.Given its specific mechanism of action, andexanet alfa may be advantageous for improving hemostatic performance in major trauma patients (1), ( 2), ( 3) .