Management of apixaban-associated subdural hematoma: a case report on the use of factor eight inhibitor bypassing activity.

Abstract

OBJECTIVE:

We report a case of a patient receiving apixaban who developed a spontaneous subdural hematoma and declining mental status that improved after administration of a single dose of factor eight inhibitor bypassing activity.

DESIGN:

Case report.

SETTING:

Comprehensive Stroke Center, Neurocritical Care Unit.

PATIENT:

A 76-year-old man presented to an outside facility with a chief complaint of headache and pain behind his right eye. A CT scan of his head revealed a subdural hematoma. The patient was transferred to our facility with worsening clinical status.

INTERVENTIONS:

After a confirmatory cranial CT scan revealed a worsening subdural hematoma with midline shift, a single dose of factor VIII inhibitor bypassing activity (25 U/kg) was administered.

MEASUREMENTS AND MAIN RESULTS:

Coagulation tests following the administration of factor VIII inhibitor bypassing activity and a follow-up CT scan confirmed hemostasis. The patient was discharged home with no focal deficits.

CONCLUSIONS:

Factor VIII inhibitor bypassing activity may be a viable, nonspecific reversal agent for life-threatening bleeding associated with apixaban.

• Authors: Derrick R Rinehart, Nicholas R Lockhart, Leslie A Hamilton, J Russell Langdon, A Shaun Rowe
• Journal: Critical care medicine (Crit Care Med) Vol. 43 Issue 6 Pg. e203-7 (Jun 2015) ISSN: 1530-0293 [Electronic] United States
• PMID: 25738855 (Publication Type: Case Reports, Journal Article)

Chemical References

• Factor Xa Inhibitors
• Pyrazoles
• Pyridones
• apixaban

Topics

• Aged
• Factor Xa Inhibitors (adverse effects)
• Hematoma, Subdural (chemically induced, physiopathology)
• Humans
• Male
• Pyrazoles (adverse effects)
• Pyridones (adverse effects)
• Tomography, X-Ray Computed