First use of andexanet alfa in the management of massive delayed hemothorax

In emergency medicine practice, massive hemothorax represents a life-threatening condition in patients with comorbidities. We present the case of a 75-year-old female patient with a massive delayed hemothorax, which developed following a chest injury sustained during a low-height fall. The patient had been on long-term rivaroxaban, a direct oral anticoagulant, due to underlying comorbid conditions. To reverse the anticoagulant effect, andexanet alfa was administered, followed by the placement of chest drainage. After evacuating the bloody pleural effusion from the pleural cavity, full lung reexpansion was achieved, with only minimal residual drainage within an hour. Following drainage removal, the patient was subsequently discharged without any complications. After follow-up, the patient remained in good condition. This case demonstrates that andexanet alfa can be an effective reversal agent in life-threatening cases of massive delayed hemothorax.