Successful Antithrombin Administration in Andexanet Alfa-Associated Heparin Resistance

Abstract

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Heparin Resistance During Cardiopulmonary Bypass in Adult Cardiac Surgery

“…77 Clinical experience with andexanet alfa is limited for elective cardiac surgeries, but several case reports have documented difficulties with intraoperative heparinization after its administration. [78][79][80] An abstract presented at the International Society on Thrombosis and Hemostasis suggested that andexanet alfa produces heparin resistance during CPB due to its binding to UFH-AT complexes and extreme doses of UFH and, sometimes, AT supplementation may be necessary to achieve adequate anticoagulation. 81…”

Andexanet-Alfa-Associated Heparin Resistance in the Context of Hemorrhagic Stroke

“…The use of AA prior to interventions with intended heparin anticoagulation has been reported to cause unresponsiveness to heparin. Few case reports from the field of cardiovascular surgery were published pointing out this problem [9][10][11]. All publications report clinical cases of patients who underwent reversal of direct FXa inhibitors with AA for life-threatening hemorrhage caused by either aortic aneurysm rupture or pericardial tamponade and subsequently developed critical intraoperative thromboembolism in the setting of periprocedural heparin administration (Table 1).…”

A New Tool in the Management of Direct-Acting Oral Anticoagulants in Emergency Cardiac Surgery

“…Andexanet alfa interacts with heparin required for systemic anticoagulation during CPB and might be associated with poor hemostatic effectiveness. 7,8,11,12 To avoid or temper the interaction of andexanet alfa with heparin, antithrombin concentrate has been advocated in a recent case report. 12 Further, the administration of prothrombin complex concentrates (PCC) instead of andexanet alfa might be considered and has been recommended prior to market approval of andexanet alfa.…”

“…7,8,11,12 To avoid or temper the interaction of andexanet alfa with heparin, antithrombin concentrate has been advocated in a recent case report. 12 Further, the administration of prothrombin complex concentrates (PCC) instead of andexanet alfa might be considered and has been recommended prior to market approval of andexanet alfa. 2,13 However, the effects of PCC in this setting might vary considerably, 2,13 and further data on safety and efficacy are warranted.…”