Coagulation Factor Xa (Recombinant), Inactivated-Zhzo (Andexanet Alfa) Hemostatic Outcomes and Thrombotic Event Incidence at an Academic Medical Center
Andexanet alfa is approved for the reversal of factor Xa inhibitors in patients with major bleeding events. We aimed to review the incidence of effective hemostasis with andexanet alfa in a real-world environment. This retrospective cohort included patients hospitalized for a major bleed that result...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2019-12-01
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| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/1076029619896619 |
| _version_ | 1819052749116932096 |
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| author | Victoria M. Stevens PharmD Toby Trujillo PharmD, FCCP, FAHA, BCPS-AQ Cardiology Scott W. Mueller PharmD, BCCCP, FCCM Robert MacLaren PharmD, FCCM, FCCP Paul M. Reynolds PharmD, BCCCP Tyree H. Kiser PharmD, FCCM, FCCP, BCPS |
| author_facet | Victoria M. Stevens PharmD Toby Trujillo PharmD, FCCP, FAHA, BCPS-AQ Cardiology Scott W. Mueller PharmD, BCCCP, FCCM Robert MacLaren PharmD, FCCM, FCCP Paul M. Reynolds PharmD, BCCCP Tyree H. Kiser PharmD, FCCM, FCCP, BCPS |
| author_sort | Victoria M. Stevens PharmD |
| collection | DOAJ |
| description | Andexanet alfa is approved for the reversal of factor Xa inhibitors in patients with major bleeding events. We aimed to review the incidence of effective hemostasis with andexanet alfa in a real-world environment. This retrospective cohort included patients hospitalized for a major bleed that resulted in andexanet alfa administration. The primary outcome was effective hemostasis at 12 hours after andexanet alfa treatment. Thromboembolic events and mortality within 30 days were also assessed. Over a 14-month period, 13 patients received andexanet alfa with a mean age of 69 ± 10 years, 54% male, 69% exposed to apixaban (31% rivaroxaban), and had intracranial (46%) and nonintracranial (54%) bleeding sites. Effective hemostasis was observed in 10 (77%) patients. Four (31%) patients experienced 5 thromboembolic events with a median time to event of 6.5 days (range: 0.5-29). Four thrombotic events occurred during the period in which anticoagulation (prophylaxis or therapeutic) was not restarted. Mortality rate was 15%. Andexanet alfa was effective in obtaining hemostasis in a majority of patients. However, the incidence of thromboembolic events was high and may be attributed to a delay in restarting anticoagulation. |
| first_indexed | 2024-12-21T12:24:47Z |
| format | Article |
| id | doaj.art-872f665bf08e410e97fa7dc0382f2cb3 |
| institution | Directory Open Access Journal |
| issn | 1938-2723 |
| language | English |
| last_indexed | 2024-12-21T12:24:47Z |
| publishDate | 2019-12-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj.art-872f665bf08e410e97fa7dc0382f2cb32022-12-21T19:04:12ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232019-12-012510.1177/1076029619896619Coagulation Factor Xa (Recombinant), Inactivated-Zhzo (Andexanet Alfa) Hemostatic Outcomes and Thrombotic Event Incidence at an Academic Medical CenterVictoria M. Stevens PharmD0Toby Trujillo PharmD, FCCP, FAHA, BCPS-AQ Cardiology1Scott W. Mueller PharmD, BCCCP, FCCM2Robert MacLaren PharmD, FCCM, FCCP3Paul M. Reynolds PharmD, BCCCP4Tyree H. Kiser PharmD, FCCM, FCCP, BCPS5 Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USAAndexanet alfa is approved for the reversal of factor Xa inhibitors in patients with major bleeding events. We aimed to review the incidence of effective hemostasis with andexanet alfa in a real-world environment. This retrospective cohort included patients hospitalized for a major bleed that resulted in andexanet alfa administration. The primary outcome was effective hemostasis at 12 hours after andexanet alfa treatment. Thromboembolic events and mortality within 30 days were also assessed. Over a 14-month period, 13 patients received andexanet alfa with a mean age of 69 ± 10 years, 54% male, 69% exposed to apixaban (31% rivaroxaban), and had intracranial (46%) and nonintracranial (54%) bleeding sites. Effective hemostasis was observed in 10 (77%) patients. Four (31%) patients experienced 5 thromboembolic events with a median time to event of 6.5 days (range: 0.5-29). Four thrombotic events occurred during the period in which anticoagulation (prophylaxis or therapeutic) was not restarted. Mortality rate was 15%. Andexanet alfa was effective in obtaining hemostasis in a majority of patients. However, the incidence of thromboembolic events was high and may be attributed to a delay in restarting anticoagulation.https://doi.org/10.1177/1076029619896619 |
| spellingShingle | Victoria M. Stevens PharmD Toby Trujillo PharmD, FCCP, FAHA, BCPS-AQ Cardiology Scott W. Mueller PharmD, BCCCP, FCCM Robert MacLaren PharmD, FCCM, FCCP Paul M. Reynolds PharmD, BCCCP Tyree H. Kiser PharmD, FCCM, FCCP, BCPS Coagulation Factor Xa (Recombinant), Inactivated-Zhzo (Andexanet Alfa) Hemostatic Outcomes and Thrombotic Event Incidence at an Academic Medical Center Clinical and Applied Thrombosis/Hemostasis |
| title | Coagulation Factor Xa (Recombinant), Inactivated-Zhzo (Andexanet Alfa) Hemostatic Outcomes and Thrombotic Event Incidence at an Academic Medical Center |
| title_full | Coagulation Factor Xa (Recombinant), Inactivated-Zhzo (Andexanet Alfa) Hemostatic Outcomes and Thrombotic Event Incidence at an Academic Medical Center |
| title_fullStr | Coagulation Factor Xa (Recombinant), Inactivated-Zhzo (Andexanet Alfa) Hemostatic Outcomes and Thrombotic Event Incidence at an Academic Medical Center |
| title_full_unstemmed | Coagulation Factor Xa (Recombinant), Inactivated-Zhzo (Andexanet Alfa) Hemostatic Outcomes and Thrombotic Event Incidence at an Academic Medical Center |
| title_short | Coagulation Factor Xa (Recombinant), Inactivated-Zhzo (Andexanet Alfa) Hemostatic Outcomes and Thrombotic Event Incidence at an Academic Medical Center |
| title_sort | coagulation factor xa recombinant inactivated zhzo andexanet alfa hemostatic outcomes and thrombotic event incidence at an academic medical center |
| url | https://doi.org/10.1177/1076029619896619 |
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