Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Am J Health Syst Pharm. 2022 Aug 5;79(16):1323-1329. doi: 10.1093/ajhp/zxac079.
To manage factor Xa (FXa) inhibitor-associated bleeding, andexanet alfa or 4-factor prothrombin concentrate (4F-PCC) has been used to restore hemostasis. However, literature on the outcomes for patients who received both andexanet alfa and 4F-PCC is limited.
We report a case series of 5 patients who received andexanet alfa plus 4F-PCC for reversal of FXa inhibitor-associated bleeding. Patients were included in this case series if they received both andexanet alfa and 4F-PCC for reversal of FXa inhibitor-associated bleeding. They were followed to either discharge or death, and in-hospital complications related to concurrent use of andexanet alfa and 4F-PCC were documented. We report an incidence of thromboembolism of 40% (2 of 5 cases) and an in-hospital mortality rate of 60% (3 of 5 cases). Taking these cases together with those in the existing literature, we found a total of 23 reported cases of safety outcomes with andexanet alfa plus 4F-PCC. The overall incidence of thromboembolism was 35% (8 of 23 cases).
This case series adds to the limited literature describing the outcomes for patients receiving andexanet alfa plus 4F-PCC. We encourage other institutions to report safety data on administering both agents.
为了处理因子 Xa（FXa）抑制剂相关出血，已经使用andexanet alfa 或 4 因子凝血酶原复合物（4F-PCC）来恢复止血。然而，关于接受 andexanet alfa 和 4F-PCC 治疗的患者结局的文献有限。
我们报告了 5 例接受 andexanet alfa 和 4F-PCC 联合治疗以逆转 FXa 抑制剂相关出血的病例系列。如果患者因 FXa 抑制剂相关出血接受 andexanet alfa 和 4F-PCC 联合治疗，则纳入本病例系列。对患者进行随访，直至出院或死亡，并记录与同时使用 andexanet alfa 和 4F-PCC 相关的院内并发症。我们报告血栓栓塞的发生率为 40%（5 例中有 2 例），院内死亡率为 60%（5 例中有 3 例）。将这些病例与现有文献中的病例相结合，我们共发现了 23 例关于 andexanet alfa 加 4F-PCC 的安全性结果报告。血栓栓塞的总发生率为 35%（23 例中有 8 例）。
本病例系列增加了关于接受 andexanet alfa 加 4F-PCC 治疗的患者结局的有限文献。我们鼓励其他机构报告使用这两种药物的安全性数据。
