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Andexanet alfa in patients with factor Xa inhibitor associated intracranial hemorrhage: the prospective observational multicenter ASTRO-DE study.
Int J Stroke
January 2025
Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
Background: Hematoma expansion after intracranial hemorrhage (ICH) in anticoagulated patients signifi-cantly influences clinical outcomes and mortality, emphasizing the need for effective reversal agents. Andexanet alfa is a specific reversal agent for factor Xa associated major bleeding.
Aims: The ASTRO-DE study collected real-world evidence on the effect of andexanet alfa on mitigat-ing hematoma expansion and altering prognosis in rivaroxaban- or apixaban-treated patients with ICH.
Anticoagulation Reversal in Intracerebral Hemorrhage: A Case Report on the Efficacy of Andexanet Alfa in an Apixaban-Treated Patient.
Cureus
November 2024
Neurosurgery, County Clinical Emergency Hospital of Sibiu, Sibiu, ROU.
Intracerebral hemorrhage (ICH) presents complex clinical challenges, particularly in patients receiving anticoagulation therapy. This case report discusses the management of acute ICH in a 60-year-old male patient on long-term apixaban therapy, who arrived at the emergency department with altered consciousness, right-sided hemiplegia, and mixed aphasia. Computed tomography (CT) imaging revealed a 70 ml left lenticular-capsular hematoma with significant mass effect, necessitating rapid intervention.
View Article and Find Full Text PDFA Case Report of Extra-pericardial Tamponade From a Low-Level Fall.
Cureus
November 2024
Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin, IRL.
Article Synopsis
- A 61-year-old man with a history of COPD, ongoing anticoagulant therapy, and pneumonia was admitted to the emergency department in critical condition due to chest pain and shortness of breath.
- A chest X-ray and CT scan revealed a large mediastinal hematoma, rib fractures, and significant blood loss requiring urgent reversal of his anticoagulant medication before surgery.
- After an emergency sternotomy to evacuate the hematoma, the patient made a full recovery, highlighting the importance of imaging in older patients with fall-related injuries and the need for careful management of anticoagulants.
The Efficacy of Andexanet Alfa for the Reversal of Factor Xa Inhibitors Is Not Influenced by Hemodilution with Different Volume Expanders.
J Clin Med
November 2024
Department of Anesthesiology, University Hospital RWTH Aachen, 52074 Aachen, Germany.
Andexanet alfa is a specific antidote for factor Xa (FXa) inhibitors. It is licensed to treat patients under FXa inhibitor therapy with life-threatening bleeding. Concomitantly, volume expanders are used to compensate for blood loss and maintain circulation.
View Article and Find Full Text PDFAndexanet Alfa-Associated Heparin Resistance in Cardiac Surgery: Mechanism and In Vitro Perspectives.
Arterioscler Thromb Vasc Biol
January 2025
Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.K., N.K.T.).
Background: Andexanet alfa (andexanet) is the only Food and Drug Administration-approved antidote for direct FXa (factor Xa) inhibitors but has been reported to cause resistance to unfractionated heparin (UFH). This has delayed anticoagulation for procedures requiring cardiopulmonary bypass. The mechanism, andexanet and UFH dose dependence, and thrombotic risk of andexanet-associated heparin resistance are unknown.
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