{"title":"Three cases of neutralization of factor Xa inhibitors with andexanet alfa under rotational thromboelastography monitoring","authors":"Takeshi Yagi, Reina Kawano, Takuto Tomokage, Ryo Ayata, Yasutaka Koga, Kotaro Kaneda, Motoki Fujita, Nanami Yamanaka, Naomasa Mori, Ryosuke Tsuruta","doi":"10.1002/ams2.954","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Factor Xa inhibitors are direct oral anticoagulants that are extremely useful in clinical applications, safe, and do not require dose adjustment. It is desirable to be able to monitor their effects in the event of hemorrhagic complications requiring neutralization. However, it is difficult to monitor their activity and neutralization using conventional coagulation tests.</p>\n </section>\n \n <section>\n \n <h3> Case Presentation</h3>\n \n <p>We report three patients taking factor Xa inhibitors who underwent rotational thromboelastography (ROTEM) monitoring before and after neutralization with andexanet alfa. All three patients had hemorrhagic complications that required neutralization of their factor Xa inhibitors using andexanet alfa. One ROTEM parameter, the EXTEM clotting time (EXTEM-CT), was immediately shortened after andexanet alfa bolus administration, without subsequent extension of the EXTEM-CT assessed 4 h after the bolus dose.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>ROTEM parameters, particularly EXTEM-CT, might be useful for monitoring neutralization of factor Xa inhibitors.</p>\n </section>\n </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.954","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acute Medicine & Surgery","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ams2.954","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
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Abstract
Background
Factor Xa inhibitors are direct oral anticoagulants that are extremely useful in clinical applications, safe, and do not require dose adjustment. It is desirable to be able to monitor their effects in the event of hemorrhagic complications requiring neutralization. However, it is difficult to monitor their activity and neutralization using conventional coagulation tests.
Case Presentation
We report three patients taking factor Xa inhibitors who underwent rotational thromboelastography (ROTEM) monitoring before and after neutralization with andexanet alfa. All three patients had hemorrhagic complications that required neutralization of their factor Xa inhibitors using andexanet alfa. One ROTEM parameter, the EXTEM clotting time (EXTEM-CT), was immediately shortened after andexanet alfa bolus administration, without subsequent extension of the EXTEM-CT assessed 4 h after the bolus dose.
Conclusion
ROTEM parameters, particularly EXTEM-CT, might be useful for monitoring neutralization of factor Xa inhibitors.
背景 Xa 因子抑制剂是一种直接口服抗凝剂，在临床应用中非常有用、安全且无需调整剂量。如果出现需要中和的出血并发症，最好能够监测其效果。然而，使用传统的凝血试验很难监测其活性和中和情况。 病例介绍 我们报告了三名服用 Xa 因子抑制剂的患者，他们在使用安赛蜜α中和前后接受了旋转血栓弹性成像（ROTEM）监测。这三位患者都出现了出血并发症，需要使用安达赛酮α中和他们的 Xa 因子抑制剂。在使用安赛克萘α栓剂后，ROTEM的一个参数，即EXTEM凝血时间（EXTEM-CT）立即缩短，而在栓剂用药4小时后评估的EXTEM-CT却没有随之延长。 结论 ROTEM 参数，尤其是 EXTEM-CT，可能有助于监测 Xa 因子抑制剂的中和作用。
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