• Derrick R Rinehart, Nicholas R Lockhart, Leslie A Hamilton, J Russell Langdon, and A Shaun Rowe.
• 1Department of Clinical Pharmacy, College of Pharmacy, The University of Tennessee Health Science Center, Knoxville, TN. 2Department of Anesthesiology, The University of Tennessee Graduate School of Medicine, Knoxville, TN.
• Crit. Care Med.. 2015 Jun 1;43(6):e203-7.

ObjectiveWe report a case of a patient receiving apixaban who developed a spontaneous subdural hematoma and declining mental status that improved after administration of a single dose of factor eight inhibitor bypassing activity.DesignCase report.SettingComprehensive Stroke Center, Neurocritical Care Unit.PatientA 76-year-old man presented to an outside facility with a chief complaint of headache and pain behind his right eye. A CT scan of his head revealed a subdural hematoma. The patient was transferred to our facility with worsening clinical status.InterventionsAfter a confirmatory cranial CT scan revealed a worsening subdural hematoma with midline shift, a single dose of factor VIII inhibitor bypassing activity (25 U/kg) was administered.Measurements And Main ResultsCoagulation tests following the administration of factor VIII inhibitor bypassing activity and a follow-up CT scan confirmed hemostasis. The patient was discharged home with no focal deficits.ConclusionsFactor VIII inhibitor bypassing activity may be a viable, nonspecific reversal agent for life-threatening bleeding associated with apixaban.

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