Andexanet Alfa-Induced Heparin Resistance: Sustained Anticoagulant Inefficacy Despite Antithrombin Therapy

Direct-acting oral anticoagulants (DOACs) are widely used as an alternative to warfarin (1). Andexanet alfa was specifically developed to reverse the effects of direct-acting factor Xa inhibitors. It acts as a decoy for factor Xa and binds to direct-acting factor Xa inhibitors, preventing them from binding to endogenous factor Xa (2). The risk of bleeding increases during emergency surgeries in patients on DOACs, necessitating the use of a neutralizing agent (3). However, Andexanet alfa also binds to unfractionated heparin (UFH)-antithrombin complexes, leading to instances of heparin resistance (4).
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Case Report Source Type: research