PMID- 38249168
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240123
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 12
DP  - 2023 Dec
TI  - A Case of Andexanet Alfa Induced Heparin Resistance in Emergent Aortic Surgery: 
      Successful Anticoagulation Management Using Antithrombin Administration.
PG  - e50856
LID - 10.7759/cureus.50856 [doi]
LID - e50856
AB  - Andexanet alfa (AnAl) is utilized for the urgent reversal of direct oral 
      anticoagulants (DOACs) in cases of severe bleeding. While the guidelines from the 
      Society of Thoracic Surgeons recommend AnAl for urgent cardiac surgery in 
      patients treated with DOACs, concerns persist regarding the potential of AnAl to 
      induce heparin resistance. This report details the case of an 85-year-old woman 
      diagnosed with acute type A aortic dissection, who received AnAl due to prior 
      edoxaban use. During the emergent aortic surgery, she exhibited heparin 
      resistance following the administration of unfractionated heparin (UFH). The 
      administration of antithrombin III (ATIII) significantly influenced activated 
      clotting times, facilitating successful surgery while maintaining adequate 
      anticoagulation. This case underscores the importance of cautious management of 
      AnAl-induced heparin resistance during critical surgeries, emphasizing the role 
      of ATIII supplementation for effective anticoagulation.
CI  - Copyright (c) 2023, Takagi et al.
FAU - Takagi, Kazuyoshi
AU  - Takagi K
AD  - Division of Cardiovascular Surgery, Department of Surgery, Kurume University, 
      Kurume, JPN.
FAU - Fukuda, Tomofumi
AU  - Fukuda T
AD  - Division of Cardiovascular Surgery, Department of Surgery, Kurume University, 
      Kurume, JPN.
FAU - Saku, Kosuke
AU  - Saku K
AD  - Division of Cardiovascular Surgery, Department of Surgery, Kurume University, 
      Kurume, JPN.
FAU - Tayama, Eiki
AU  - Tayama E
AD  - Division of Cardiovascular Surgery, Department of Surgery, Kurume University, 
      Kurume, JPN.
LA  - eng
PT  - Case Reports
DEP - 20231220
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10798854
OTO - NOTNLM
OT  - act
OT  - andexanet alfa
OT  - antithrombin iii
OT  - aortic dissection management
OT  - heparin resistance
COIS- The authors have declared that no competing interests exist.
EDAT- 2024/01/22 06:42
MHDA- 2024/01/22 06:43
PMCR- 2023/12/20
CRDT- 2024/01/22 04:48
PHST- 2023/12/20 00:00 [accepted]
PHST- 2024/01/22 06:43 [medline]
PHST- 2024/01/22 06:42 [pubmed]
PHST- 2024/01/22 04:48 [entrez]
PHST- 2023/12/20 00:00 [pmc-release]
AID - 10.7759/cureus.50856 [doi]
PST - epublish
SO  - Cureus. 2023 Dec 20;15(12):e50856. doi: 10.7759/cureus.50856. eCollection 2023 
      Dec.