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Andexanet Alfa Use in Cardiac Surgical Patients: A Xa Inhibitor and Heparin Reversal Agent
THE NONVITAMIN K direct oral anticoagulants (DOACs) currently are approved for clinical use for the prevention of cerebrovascular embolic stroke in patients with nonvalvular atrial fibrillation, and as antithrombotic therapy and prophylaxis.1 As a result, clinicians should be aware of perioperative management strategies for both elective and emergency surgery in patients receiving these agents. Currently, specific reversal agents, also referred to as antidotes, are available for dabigatran (idarucizumab) and Xa inhibitors (andexanet alfa).
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 13, 2020 Category: Anesthesiology Authors: Jerrold H. Levy, Jean M. Connors Tags: Editorial Source Type: research

A Case of Fatal Bleeding Following Emergency Surgery on an Ascending Aorta Intramural Hematoma in a Patient Taking Dabigatran
INTRAMURAL HEMATOMA (IMH) is an acute aortic syndrome. More frequently—in 60% to 70% of cases—IMH involves the descending aorta (type B), whereas the involvement of the ascending aorta and aortic arch accounts for 30% and 10% of the cases, respectively. Hospital mortality of type-A IMH is similar to type-A aortic dissection. Cardiocirculatory shock secondary to cardiac tamponade, together with stroke, coma, and impaired coronary perfusion, are important predictive factors of postoperative mortality.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 13, 2016 Category: Anesthesiology Authors: Giulia Beatrice Crapelli, Paolo Bianchi, Giuseppe Isgrò, Andrea Biondi, Carlo de Vincentiis, Marco Ranucci Tags: Case Report Source Type: research

The Effect of Cardiopulmonary Bypass on Dabigatran Levels
DABIGATRAN IS a novel anticoagulant that is licensed for use for the prevention of stroke in the presence of atrial fibrillation. Its use has expanded rapidly in New Zealand, primarily due to there being no requirement for routine monitoring of its effect, as there is for warfarin. There are case reports in the literature describing management of patients coming for urgent cardiac surgery, which revolve mainly around the use of dialysis and massive transfusion of clotting factors to manage the bleeding associated with surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 31, 2015 Category: Anesthesiology Authors: Kelly Byrne Tags: CASE REPORT Source Type: research

Management of Direct Oral Anticoagulants in the Perioperative Setting
AN INCREASING NUMBER of patients undergoing surgical procedures are treated chronically by oral anticoagulants (OAC). Vitamin K antagonists (VKAs) have been standard practice in chronic anticoagulant therapy for decades. Despite a proved efficacy, they have several disadvantages. Over the past 5 years, direct oral anticoagulants (DOAs) such as dabigatran, rivaroxaban, apixaban, and edoxaban have been approved for several indications for long-term anticoagulation. Consequently, with the aging population and the extension of the indication of anticoagulation for stroke prevention in nonvalvular atrial fibrillation (AF), ther...
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 24, 2015 Category: Anesthesiology Authors: Olivier Untereiner, Pierre-François Seince, Vladimir Chterev, Isabelle Leblanc, Clarisse Berroëta, Patrick Bourel, Ivan Philip Tags: Review ArticlesGiovanni Landoni, MDSection Editors? > Source Type: research

Case 4–2015
ATRIAL FIBRILLATION (AF) is the most common cardiac arrhythmia in the world and is estimated to affect more than 3 million people in the United States, with a projected increase to more than 5 million people in the US by the year 2050.1 AF is an independent risk factor for stroke and is associated with a four- to five-fold increased risk of embolic stroke compared with those individuals without AF. Oral anticoagulation therapy with warfarin or other agents (dabigatran, apixaban) significantly reduces the risk of stroke in this population; however, anticoagulation carries inherent risks.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 18, 2015 Category: Anesthesiology Authors: Megan J. Lanigan, Mark A. Chaney, Sandeep Nathan, Atman P. Shah, Andrew J. Feider Tags: Case Conference Source Type: research