This pilot study suggests low-intensity anti-coagulation targeting an INR between 1.5 and 1.9 is achievable and safe with the HeartMate 3 cardiac pump in the short-term phase, 6-months post-implant. A large-scale trial is now warranted.
Clinical uncertainty exists regarding which assay should be designated as the standard
monitoring coagulation test for intravenous unfractionated heparin (UFH). Several studies
have compared the use of activated partial thromboplastin time (aPTT) and antifactor-Xa
(anti-Xa) and have come out with varying results. The correlation between these 2 tests
varied, markedly from strong to weak. Some have demonstrated that monitoring with anti-Xa
heparin assay leads to fewer dose adjustments, resulting in fewer laboratory tests, while
others have not. In the current study, we evaluated the correlation between aPTT and
anti-Xa values to guide clinical management of UFH, with the intention to develop a new
correlation nomogram.
Andexanet alfa is a recombinant factor Xa decoy molecule capable of reversing direct and indirect factor Xa–inhibiting anticoagulants. We present an adult patient on apixaban for nonvalvular atrial fibrillation who required urgent reoperative aortic surgery for an aortic root pseudoaneurysm. Apixaban was reversed with andexanet alfa. A second dose of andexanet alfa was required before surgical incision for persistently elevated antifactor Xa levels. Intraoperative management required use of cardiopulmonary bypass (CPB). No major adverse cardiovascular, cerebrovascular, hemorrhagic, or thromboembolic events were observed.
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