PMID- 31251821
OWN - NLM
STAT- MEDLINE
DCOM- 20200504
LR  - 20200505
IS  - 1875-9114 (Electronic)
IS  - 0277-0008 (Linking)
VI  - 39
IP  - 8
DP  - 2019 Aug
TI  - Intraoperative Unfractionated Heparin Unresponsiveness during Endovascular Repair 
      of a Ruptured Abdominal Aortic Aneurysm following Administration of Andexanet 
      Alfa for the Reversal of Rivaroxaban.
PG  - 861-865
LID - 10.1002/phar.2306 [doi]
AB  - The authors describe a case of unfractionated heparin (UFH) unresponsiveness in 
      the operating room secondary to reversal of rivaroxaban with coagulation factor 
      Xa (recombinant) inactivated-zhzo (andexanet alfa). A 70-year-old man with a 
      known 4.5- to 5.0-cm abdominal aortic aneurysm and atrial fibrillation managed 
      with rivaroxaban presented with severe right-sided flank pain radiating to the 
      left side of his abdomen. Computed tomography-angiography on arrival demonstrated 
      a left retroperitoneal hematoma and a suspected ruptured abdominal aortic 
      aneurysm. He received andexanet alfa to reverse rivaroxaban prior to an emergent 
      endovascular aneurysm repair. During surgery, he received a total of 14,000 units 
      (167 units/kg) of UFH with minimal changes in activated clotting time 
      (132-144 sec; baseline 135 sec [reference range 74-137 sec]). This case 
      highlights the potential complications of using UFH anticoagulation following 
      reversal of factor Xa inhibitors with andexanet alfa and underscores the 
      importance of peri-procedural anticoagulation planning. For patients who require 
      intra-operative anticoagulation, providers should consider anticoagulation 
      reversal with prothrombin complex concentrate instead of andexanet alfa or 
      administration of a parenteral direct thrombin inhibitor, such as argatroban or 
      bivalirudin during the surgical procedure.
CI  - (c) 2019 Pharmacotherapy Publications, Inc.
FAU - Eche, Ifeoma Mary
AU  - Eche IM
AD  - Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts.
FAU - Elsamadisi, Pansy
AU  - Elsamadisi P
AUID- ORCID: 0000-0003-0302-6006
AD  - Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts.
FAU - Wex, Nicole
AU  - Wex N
AD  - Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts.
FAU - Wyers, Mark C
AU  - Wyers MC
AD  - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical 
      Center, Boston, Massachusetts.
FAU - Brat, Gabriel A
AU  - Brat GA
AD  - Division of Acute Care Surgery, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts.
FAU - Cunningham, Katherine
AU  - Cunningham K
AD  - Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts.
FAU - Bauer, Kenneth A
AU  - Bauer KA
AD  - Division of Hemostasis and Thrombosis, Department of Hematology, Beth Israel 
      Deaconess Medical Center, Boston, Massachusetts.
LA  - eng
PT  - Case Reports
DEP - 20190718
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Anticoagulants)
RN  - 0 (PRT064445)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*administration & dosage
MH  - Aortic Aneurysm, Abdominal/*surgery
MH  - Aortic Rupture/*surgery
MH  - Factor Xa/adverse effects
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Intraoperative Period
MH  - Male
MH  - Recombinant Proteins/adverse effects
MH  - Rivaroxaban/adverse effects
MH  - Treatment Failure
OTO - NOTNLM
OT  - abdominal aortic aneurysm
OT  - andexanet alfa
OT  - direct oral anticoagulants
OT  - endovascular aneurysm repair
OT  - endovascular repair
OT  - factor Xa reversal
OT  - rivaroxaban
OT  - unfractionated heparin unresponsiveness
EDAT- 2019/06/30 06:00
MHDA- 2020/05/06 06:00
CRDT- 2019/06/29 06:00
PHST- 2019/06/30 06:00 [pubmed]
PHST- 2020/05/06 06:00 [medline]
PHST- 2019/06/29 06:00 [entrez]
AID - 10.1002/phar.2306 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2019 Aug;39(8):861-865. doi: 10.1002/phar.2306. Epub 2019 Jul 
      18.