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Intraoperative Heparin Resistance after Administration of Andexanet Alfa to Manage an Internal Iliac Artery Aneurysm

Kanetsugu Nagao1, Shigeyuki Yamashita1, Rina Ebe1

  • 1First Department of Surgery, University of Toyama, Toyama, Toyama, Japan.

Annals of Vascular Diseases
|January 8, 2024
PubMed

Antithrombotic agents are increasingly prescribed to older adults; however, they are associated with bleeding-related complications. We describe a case of intraoperative heparin resistance after administration of andexanet alfa (AA). An 81-year-old man was diagnosed with a ruptured internal iliac artery aneurysm. The patient required emergency endovascular aneurysm repair and was treated with AA because he was receiving apixaban. Despite high-dose intraoperative heparin administration, his activated coagulation time was not prolonged. Our findings suggest that AA should be administered with caution in patients experiencing potentially fatal bleeding (requiring surgical intervention) who are also receiving direct oral anticoagulants.

Keywords:
andexanet alfaendovascular aneurysm repairheparin resistance

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