Anticoagulants/andexanet alfa
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Anticoagulants/andexanet alfa Lack of efficacy and haemorrhages: 22 case reports
In a retrospective observational study of 25 patients, 22 patients (13 women and 9 men) aged 44–94 years were described, who developed intracranial haemorrhage (ICH), extracranial bleeding including gastrointestinal site bleeding during anticoagulation with apixaban or rivaroxaban for deep vein thrombosis (DVT), pulmonary embolism (PE), atrial fibrillation (AF) or peripheral arterial disease (PAD). Out of the 22 patients, 6 patients experienced lack of effectiveness during reversal of anticoagulation with andexanet alfa, which eventually led to haematoma expansion or death [not all dosages stated; routes and durations of treatment to reactions onset not stated]. The patients were diagnosed with DVT, PE, AF or PAD along with various concurrent conditions. The patients started receiving anticoagulation with apixaban at twice daily doses of 2.5mg (n=3), 5mg (n=12), 10mg (n=2) and rivaroxaban at once daily doses of 10mg (n=1), 15mg (n=3) and 20mg (n=1). Thirteen patients developed ICH (intraparenchymal haemorrhage (IPH; n=9) intraventricular haemorrhage (IVH; n=1), subarachnoid haemorrhage (SAH; n=1), subdural haematoma (SDH; n=2) confirmed by clinical findings. Nine patients developed extracranial bleeding including the gastrointestinal site bleeding (n=4). The patients received low or high dose of andexanet alfa for reversal of anticoagulation during admission. Out of the 13 patients with ICH, haematoma was non-evaluable in two patients, including one patient who underwent right craniotomy for haematoma evacuation. Out of the remaining 11 patients, only one patient had haematoma expansion. Out of the 22 patients, a total of six patients subsequently experienced lack of effectiveness with andexanet alfa, which resulted in haematoma expansion (n=1) and death (n=5). Seven patients had also required additional blood products within 24 hours of reversal [not all outcomes stated]. Brown CS, et al. Real-world utilization of andexanet alfa. American Journal of Emergency Medicine 38: 810-814, No. 4, Apr 2020. Available from: URL: http:// doi.org/10.1016/j.ajem.2019.12.008
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Reactions 5 Sep 2020 No. 1820
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