• A&A practice · Nov 2022

    Case Reports

    Heparin Insensitivity and Thrombotic Risk Associated With Sequential Uses of Prothrombin Complex Concentrate and Andexanet Alfa for Apixaban Reversal During Acute Type A Aortic Dissection Repair: A Case Report.

    • Brian Brenner, Jessica Guerra, Campbell Williams, Keith Littlewood, John Kern, Kenichi Tanaka, John S McNeil, and Venkat Mangunta.
    • From the Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of Virginia, Charlottesville, Virginia.
    • A A Pract. 2022 Nov 1; 16 (11): e01636e01636.

    AbstractThe management of patients on direct oral anticoagulants (DOACs) who require emergent cardiac surgery is slowly evolving. The introduction of andexanet alfa, a novel antidote for apixaban and rivaroxaban, added a specific reversal agent to our armamentarium, but its safety and efficacy are still being investigated. We report 2 patients on DOAC treatment who required emergency cardiac surgery. Both received perioperative andexanet alfa together with prothrombin complex concentrate (PCC) at some time during 6 hours before operative management. Heparin resistance was noted in each instance, and pump thrombosis developed in 1 case.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Anesthesia Research Society.

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