University of Kentucky HealthCare, Chandler Hospital, Emergency Department and Pharmacy Services, 1000 South Limestone, Lexington, KY 40503, USA.
Am J Emerg Med. 2022 Dec;62:144.e1-144.e3. doi: 10.1016/j.ajem.2022.08.041. Epub 2022 Aug 21.
With respect to reversal of life threatening bleeds associated with the use of oral factor Xa inhibitors, current guidelines provide few recommendations for a preferred reversal agent. When the initial reversal agent fails to achieve the desired hemostatic response, there is little to no recommendations for the use of additional reversal agents.
An 86-year-old female on apixaban (ELIQUIS) for atrial fibrillation, presented from an outside hospital due to a spontaneous intracranial hemorrhage (sICH). Computed tomography (CT) scan revealed multifocal left sided sICH. Due to use of apixaban in the setting to sICH, patient received andexanet alfa (AA) for reversal. Patient was then transferred and upon arrival to receiving emergency department (ED), repeat CT scans showed an expanding sICH, progression of midline shift, and low-molecular weight heparin levels that were ≥ 2 international units (IU) per milliliter (mL), indicating therapeutic apixaban activity. The patient was subsequently given four-factor prothrombin complex concentrate (4F-PCC). WHY AN EMERGENCY MEDICINE PHYSICIAN SHOULD BE AWARE OF THIS INCLUDE THE FOLLOWING KEY POINTS.
对于与使用口服因子 Xa 抑制剂相关的危及生命的出血逆转，目前的指南几乎没有提供首选逆转剂的建议。当最初的逆转剂未能达到预期的止血反应时，几乎没有建议使用其他逆转剂。
一名 86 岁女性因房颤服用阿哌沙班（ELIQUIS），因自发性颅内出血（sICH）从外院转入。计算机断层扫描（CT）显示左侧多发性 sICH。由于 sICH 患者使用了阿哌沙班，给予氨甲环酸（AA）逆转。随后患者转入急诊科（ED），到达后复查 CT 显示 sICH 扩大、中线移位进展、低分子肝素水平≥2 国际单位（IU）/毫升（mL），提示有治疗性阿哌沙班活性。随后给予了 4 因子凝血酶原复合物浓缩物（4F-PCC）。
为什么急诊医师应该了解这一点，包括以下要点：
