Mehrara Shaheen, Patel Ravi, DeRon Nathan
Department of Internal Medicine, Methodist Dallas Medical Center, 1441 North Beckley Avenue, Dallas, TX 75203, USA.
Eur Heart J Case Rep. 2025 Mar 24;9(4):ytaf136. doi: 10.1093/ehjcr/ytaf136. eCollection 2025 Apr.
Direct oral anticoagulants, such as direct factor Xa inhibitors, are commonly used to treat and prevent blood clots in patients with atrial fibrillation. Andexanet alfa reverses direct factor Xa inhibitors to help treat various thromboembolic conditions. Although it efficiently reverses anticoagulation by preventing life-threatening bleeding events, the use of andexanet alfa in today's clinical practice is limited due to the risk of thromboembolism and cost.
A 76-year-old male presented with atrial fibrillation with rapid ventricular response and was started on Eliquis after a successful direct current cardioversion. Subsequently, the patient developed intracerebral haemorrhage, which required the administration of andexanet alfa. Ultimately, the patient suffered an ST-segment elevation myocardial infarction from complete occlusion of the mid-left anterior descending artery. His hospital course was complicated by acute hypoxic respiratory failure, septic shock, and renal failure. The family elected for comfort care measures and the patient expired shortly after.
This case emphasizes the need for individualized clinical assessment and collaboration with an interdisciplinary team regarding the use of andexanet alfa, as well as strategies to ensure thrombotic risk is effectively minimized. Current European Society of Cardiology Guidelines do not have recommendations for the use of andexanet alfa for the reversal of anticoagulation due to its uncertain risk profile. This case emphasizes the increased risk of thrombotic complications associated with andexanet alfa and highlights the importance of the continued need to research its use, which may help elucidate or revise current guidelines.
直接口服抗凝剂，如直接凝血因子Xa抑制剂，常用于治疗和预防心房颤动患者的血栓形成。安多凝血素α可逆转直接凝血因子Xa抑制剂，有助于治疗各种血栓栓塞性疾病。尽管它通过预防危及生命的出血事件有效地逆转了抗凝作用，但由于血栓栓塞风险和成本，安多凝血素α在当今临床实践中的应用有限。
一名76岁男性因心房颤动伴快速心室反应就诊，在成功进行直流电复律后开始服用艾乐妥。随后，患者发生脑出血，需要使用安多凝血素α。最终，患者因左前降支中段完全闭塞发生ST段抬高型心肌梗死。他的住院过程因急性低氧性呼吸衰竭、感染性休克和肾衰竭而复杂化。家属选择了舒适护理措施，患者不久后去世。
本病例强调了在使用安多凝血素α时进行个体化临床评估并与多学科团队合作的必要性，以及确保血栓形成风险有效降至最低的策略。由于其风险状况不确定，欧洲心脏病学会现行指南未就使用安多凝血素α逆转抗凝作用给出建议。本病例强调了与安多凝血素α相关的血栓形成并发症风险增加，并突出了继续研究其用途的重要性，这可能有助于阐明或修订现行指南。
