Use of Andexanet Alfa to Reverse Heparin After Cardiopulmonary Bypass

Heparin is the primary anticoagulant used for cardiopulmonary bypass and requires reversal to prevent postoperative bleeding. Protamine sulfate is the only United States Food and Drug Administration-approved heparin reversal agent and therefore is routinely used after cardiopulmonary bypass. Severe intraoperative protamine reactions are infrequent but may preclude full heparin reversal. Andexanet alfa has demonstrated effective in vitro heparin reversal, but clinical use has not been reported. We review the preclinical data on andexanet alfa as a heparin reversal agent and report a clinical case of andexanet alfa infusion, with complete laboratory and clinical evidence of heparin reversal.