Temporal Coagulation Biomarker Profiles After Andexanet Alfa Use for Procedure-Related Cardiac Tamponade

Area of Science:

• Cardiology
• Hematology
• Pharmacology

Background:

• Cardiac tamponade is a serious complication of invasive arrhythmia procedures.
• Andexanet alfa is used for refractory bleeding in patients on factor Xa inhibitors, but its effect on coagulation biomarkers in this setting is not well understood.

Purpose of the Study:

• To investigate the temporal changes in coagulation biomarkers following andexanet alfa administration in patients with procedure-related cardiac tamponade.
• To evaluate the safety and efficacy of andexanet alfa in managing cardiac tamponade in patients receiving factor Xa inhibitors.

Main Methods:

• A single-center retrospective observational study of 15 patients with cardiac tamponade.
• Patients were divided into two groups: those treated with andexanet alfa and those managed without.
• Coagulation parameters were assessed at multiple time points before and after tamponade onset through day three.

Main Results:

• Four patients received andexanet alfa; all achieved hemostasis. These patients were on edoxaban for atrial fibrillation.
• Andexanet alfa treatment was associated with a distinct biomarker pattern: early increases in thrombin-antithrombin complex and prothrombin fragment 1+2, with D-dimer higher on day one.
• No thromboembolic complications were observed in the andexanet alfa group during hospitalization.

Conclusions:

• Andexanet alfa facilitated prompt hemostasis in patients with cardiac tamponade and factor Xa inhibitor use.
• The administration of andexanet alfa was associated with early procoagulant marker increases and later fibrin turnover.
• These findings suggest andexanet alfa can be carefully used as rescue therapy, with attention to potential early procoagulant changes.