Factor XIa Inhibitor Reversal in Intracranial Hemorrhage: A Case Report

Area of Science:

• Hematology
• Pharmacology
• Clinical Trials

Background:

• Factor XIa (FXIa) inhibitors are novel anticoagulants under investigation.
• Optimal reversal strategies for FXIa inhibitor-associated hemorrhage are not established.
• Life-threatening bleeding requires prompt and effective management.

Observation:

• An 82-year-old female on an FXIa inhibitor developed a subdural hematoma after a fall.
• Standard reversal with 4-factor prothrombin complex concentrate (PCC) was ineffective.
• The patient received recombinant activated factor VII (rFVIIa) and tranexamic acid (TXA) for intracranial bleeding.

Findings:

• Despite treatment, the patient's clinical condition declined, leading to withdrawal of care.
• This case highlights the challenges in managing bleeding events associated with FXIa inhibitors.
• The combination of rFVIIa and TXA was used in an attempt to reverse anticoagulation.

Implications:

• Clinicians should consider using low-dose rFVIIa with an anti-fibrinolytic like TXA for FXIa inhibitor-related hemorrhage.
• This approach may offer a potential strategy for managing bleeding in patients participating in FXIa inhibitor trials.
• Further research is needed to confirm the efficacy and safety of this reversal combination.