521: Anti-inhibitor coagulant complex for hemorrhage reversal in patients taking apixaban and rivaroxaban.

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Critical Care Medicine


Introduction/Hypothesis: Coagulation factor Xa (recombinant), inactivated-zhzo (Andexxa) was recently approved for apixaban or rivaroxaban life-threatening or uncontrolled bleeding. Despite the availability of Andexxa, our institution guideline for direct Xa inhibitor reversal for bleeding recommends anti-inhibitor coagulant complex (FEIBA) 25-50 units/kg. This study evaluated the compliance with our internal FEIBA guideline, the overall approach to bleed management and patient outcomes in patients with apixaban or rivaroxaban hemorrhage receiving FEIBA. Methods: This single center retrospective cohort study included patients from August 2016 through July 2018 who received FEIBA for an apixaban or rivaroxaban hemorrhage. Data extraction using a systematic process consisted of demographic information, laboratory data, antiplatelet therapy, diagnostic tests, bleed site, surgical/procedural interventions, FEIBA dose, blood product use and mortality. The hemorrhage was classified as major, clinically relevant orminor. Outcomes included hemorrhage progression (objective documentation in electronic medical record), in hospital mortality and thrombotic events within 30 days. Descriptive statistics were employed. Results: Forty-one patients (21 apixaban and 20 rivaroxaban) were assessed with a mean age of 74 ± 11 years. The majority, 93%, met criteria for a major bleed. More than half of patients, 63.4%, were on concurrent aspirin. Intracranial hemorrhage was present in 51% and gastrointestinal in 12%. FEIBA use was in accordance with guidelines in 38/41 patients, 93%. Two patients received an inappropriate dose and one patient received a second dose earlier than recommended. The average FEIBA dose was 36 ± 14 units/kg. Fourteen patients (34.1%) underwent a procedure/surgery and 8 patients (20%) received fresh frozen plasma (FFP). Nine patients (22%) had evidence of hemorrhage progression, five of whom had renal impairment. In hospital mortality was 24%. Six patients (14.6%) experienced a thrombotic event within 30 days, all prior to anticoagulant resumption. Conclusions: FEIBA use was in accordance with our institution guideline in the majority of patients. Clinician education on the limited role of FFP in direct Xa agent reversal is needed. Evidence of hemorrhagic progression post FEIBA was present in 22% of cases





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