Andexanet alfa is a recombinant factor Xa decoy molecule capable of reversing direct and indirect factor Xa–inhibiting anticoagulants. We present an adult patient on apixaban for nonvalvular atrial fibrillation who required urgent reoperative aortic surgery for an aortic root pseudoaneurysm. Apixaban was reversed with andexanet alfa. A second dose of andexanet alfa was required before surgical incision for persistently elevated antifactor Xa levels. Intraoperative management required use of cardiopulmonary bypass (CPB). No major adverse cardiovascular, cerebrovascular, hemorrhagic, or thromboembolic events were observed.
From the *Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
†Division of Hematology, Brigham and Women’s Hospital, Boston, Massachusetts
‡Division of Cardiac Surgery, Trillium Health Partners, University of Toronto, Toronto, Ontario, Canada
§Division of Pharmacy, Brigham and Women’s Hospital, Boston, Massachusetts.
Accepted for publication May 13, 2019.
The authors declare no conflicts of interest.
Address correspondence to Devon Flaherty, MD, Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. Address e-mail to firstname.lastname@example.org.