Fatal drug reaction to andexanet alfa: a case report.
Richard John BukaMamidipudi T KrishnaDavid J SuttonPublished in: EJHaem (2024)
Andexanet alfa is a recombinant, modified factor Xa (FXa) molecule that is used for the reversal of the anticoagulant effect of oral anti-FXa anticoagulants in patients with major haemorrhage. Here, we present a case of an 85-year-old man taking rivaroxaban for atrial fibrillation, who presented with an acute, upper gastrointestinal bleed. He was stabilised with red cell transfusion and then received a 400 mg bolus of andexanet alfa. Within minutes of this, he developed chest tightness, shortness of breath, ischaemic electrocardiographic changes and then cardiac arrest from which he could not be resuscitated. The onset of symptoms was clearly temporally related to andexanet alfa administration and the differential diagnosis includes anaphylaxis with Kounis syndrome, or myocardial infarction. Although infusion site reactions have been reported and are relatively common, this is to date the first case of a fatal drug reaction andexanet alfa. This knowledge can be factored into physicians' risk-benefit decisions when treating patients with oral anti-FXa anticoagulant-associated major haemorrhage.
Keyphrases
- atrial fibrillation
- cardiac arrest
- replacement therapy
- venous thromboembolism
- left atrial
- cardiopulmonary resuscitation
- heart failure
- left ventricular
- drug induced
- direct oral anticoagulants
- primary care
- oral anticoagulants
- catheter ablation
- left atrial appendage
- healthcare
- single cell
- percutaneous coronary intervention
- cell therapy
- pulmonary embolism
- cardiac surgery
- emergency department
- adverse drug
- bone marrow
- coronary artery disease
- acute coronary syndrome
- depressive symptoms
- extracorporeal membrane oxygenation