This challenge is compounded by a lack of reliable and readily available laboratory means of monitoring the anticoagulant effect of NOACs. These findings suggest that development of, and adherence to, administration guidelines are required to ensure safe and appropriate administration of andexanet alfa.As the utilization of non-vitamin K oral anticoagulants (NOACs) increases among patients with non-valvular atrial fibrillation, the management of bleeding episodes and emergent periprocedural risk reduction remains an important clinical challenge. The last dose of anti-Xa inhibitor was administered greater than 8 hours prior to factor Xa reversal with andexanet in over half of patients. All adverse events occurred within 8 days of andexanet administration.Ĭonclusion(s): Many patients received inappropriate administration of andexanet and received additional reversal/hemostatic agents. Five patients experienced adverse events within 30 days: 4 deaths (26.7%) and 1 stroke (6.7%). Three patients received an agent at an outside hospital. Seven patients received ≥1 additional reversal/hemostatic agent: prothrombin complex concentrate (5, 33.3%), desmopressin (2, 13.3%), fresh frozen plasma (1, 6.7%), and phytonadione (1, 6.7%). Infusion times ranged from 39 minutes to 12 hours, with a median time of 2 hours. Per dosing guidelines, three patients on rivaroxaban were administered incorrect doses (too low, too high, and incorrect infusion rate, respectively). Last dose of anti-Xa inhibitor was 8 hours in 8 (53.3%). The most common indication for andexanet was intracranial bleeding (73.3%).
Median patient age was 68 (interquartile range: 58-75), 60% were female, 80% were white, and 66% were receiving apixaban. Results: We identified 18 orders for andexanet between 2018-2022 15 were administered. Methods: This was a case series of adult patients who were administered andexanet for anti-Xa inhibitor reversal. Theme: Venous Thromboembolism » VTE Treatmentīackground: While andexanet has been approved for reversal of the anti-Xa inhibitors apixaban and rivaroxaban, few studies have described important aspects of real-world clinical use such as dosing, timing in relationship to last dose of oral anticoagulant, and outcomes related to safety and effectiveness.Īims: Describe use and 30-day patient outcomes of andexanet for anti-Xa reversal at an academic medical center.
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