Category: Professional Posters
Andexanet alfa was approved for intravenous administration by the U.S. Food & Drug Administration (FDA) in May 2018 for the reversal of apixaban or rivaroxaban. Since its approval, there has been minimal experience with its use, as well as limited published literature on outcomes at other healthcare centers. This case illustrates the initial use of andexanet alfa for apixaban reversal in a community hospital setting. The patient was an 82-year-old female taking apixaban 5 mg by mouth twice daily for stroke prevention in atrial fibrillation. She presented to the Emergency Department from home with expressive aphasia. She met the hospital initial inclusion criteria for administration of andexanet alfa, which included the ingestion of apixaban within 18 hours of presentation. Upon results from computed tomography angiography (CTA), the patient was found to have left-sided acute parietal/occipital intracerebral hemorrhage with surrounding edema. The decision to initiate andexanet alfa was guided by strict hospital criteria in addition to an interdisciplinary team consisting of the emergency department physician, neurosurgery, teleneurology, an intensivist and emergency room pharmacist. The case had a positive outcome and the patient was discharged to subacute rehabilitation after an 8-day hospital stay. This case will provide guidance to other hospitals and healthcare centers that are in the process of considering the addition of andexanet alfa to their formulary with regards to appropriate criteria for its use.