This patient died in the hospital on day 12 after experiencing an internal carotid artery and middle cerebral artery infarct on hospital day 10. They received 25 units/kg of 4FPCC and, after hemostasis was judged to be inadequate, low dose andexanet alfa. Patient #2 was taking apixaban 5 mg twice daily and presented with subdural hematoma. This patient died in the hospital on day 1 and experienced a STEMI.
They received 42 units/kg of 4FPCC and, after hemostasis was judged to be inadequate, high dose andexanet alfa. Patient #1 was taking rivaroxaban 15 mg daily and presented with intraparenchymal and intraventricular hemorrhage. Some institutions, such as the one the authors of the case series practice at, use andexanet alfa only if hemostasis after 4FPCC is inadequate. There are no guideline recommendations that suggest using both Four-factor prothrombin complex concentrate and andexanet alfa for reversal of factor Xa inhibitor–associated bleeding. There is scant literature on patient outcomes when both Four-factor prothrombin complex concentrate plus andexanet alfa are used for reversal of factor Xa inhibitor–associated bleeding.Ī case series detailing 5 patients who received this combination was recently published in the American Journal of Health-System Pharmacy. Subscribe on iTunes, Android, or Stitcher
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