Current trends in the duration of anticoagulant therapy for venous thromboembolism: a systematic review.
1 Alexander P, Visagan S, Issa R, et al.Further prospective, comparative clinical research is warranted.
ConclusionĪndexanet alfa may be used for urgent or emergent reversal of apixaban and rivaroxaban peri-procedurally with promising hemostatic outcomes. Prothrombin time and antifactor Xa assay results were significantly decreased after andexanet alfa administration ( p < 0.05) while thromboelastogram assay values (reaction time, kinetic time, and activated clotting time) showed nonsignificant changes pre- versus postreversal. Thirty-day mortality and thromboischemic complications occurred in 15 (34.1%) and 12 (27.3%) patients, respectively. Discharge disposition was most often to a short- or long-term care facilities (27 ). 11 rivaroxaban 12 intracranial events vs. Overall, 30 (78.9%) patients achieved excellent or good hemostasis within 24 h after periprocedural administration of andexanet alfa (19 apixaban vs. Thirty-eight (86.4%) patients were able to be adequately graded for hemostatic efficacy. Majority of patients required emergent operative procedures (18 ), followed by invasive device placement (10 ) or arterial embolization (9 ). The indications for reversal were categorized as intracranial ( n = 20 ) or extracranial ( n = 24 ) sites. Resultsįorty-four patients met inclusion criteria of these, 27 (62.8%) received apixaban and 16 (37.2%) were treated with rivaroxaban prior to admission. Secondary outcomes included hospital discharge disposition, intensive care unit (ICU) and hospital length of stay, 30-day mortality, 30-day thromboischemic event rates, and serum coagulation assay changes pre- and postreversal. The primary outcome was hemostatic efficacy graded as excellent, good, or poor using similar definitions to the ANNEXA-4 criteria. This single-center, observational, retrospective study included patients who received andexanet alfa within 24 h of an invasive or surgical procedure. This study aimed to describe efficacy and safety outcomes following andexanet alfa administration within 24 h of an invasive procedure. Outcomes following andexanet alfa reversal of factor Xa inhibitors in patients requiring urgent or emergent invasive procedures are lacking.
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