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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
05:26

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Acute coronary syndrome during active infusion of andexanet alfa

Vishal Dalal1, Gwang-Yee J Hu, Rocco A Panico

  • 1At Robert Wood Johnson University Hospital Somerset in Somerville, NJ, Vishal Dalal, Rocco A. Panico , and Michael B. Rodricks practice critical care medicine, and Gwang-Yee J. Hu is a critical care pharmacist. V. Dalal is also an adjunct instructor in the Rutgers School of Health Professions Department of Physician Assistant Studies and Practice in Piscataway, NJ, and is a clinical instructor in the Department of Medicine at Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ. M.B. Rodricks is an associate professor in the Division of Acute Care Surgery at Rutgers Robert Wood Johnson Medical School. G.Y. J. Hu is a clinical assistant professor at the Ernest Mario School of Pharmacy in Piscataway, NJ. V. Dalal discloses service as a consultant for Teleflex Medical Incorporated. The authors have disclosed no other potential conflicts of interest, financial or otherwise.

JAAPA : Official Journal of the American Academy of Physician Assistants
|June 23, 2026
PubMed

Now withdrawn from the US market, andexanet alfa was initially approved by the FDA in 2018 to reverse life-threatening bleeds associated with factor Xa (FXa) inhibitors, specifically apixaban and rivaroxaban. Observed effects of andexanet alfa include a reduction in anti-FXa activity resulting in hemostatic efficacy. However, thrombotic events including myocardial infarction and deep venous thrombosis, typically occurring 6 to 30 days after infusion, have also been observed. This case presents the first known patient to develop an ST-segment elevation myocardial infarction while actively receiving infusion of andexanet alfa, which was an approved therapy at the time of the patient's treatment.

Keywords:
STEMIacute coronary syndromeandexanet alfaapixabanfactor Xathrombosis

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