Effectiveness of andexanet alfa in the management of traumatic intracranial hemorrhage associated with factor Xa inhibitors

Abstract

Many elderly patients take oral anti–thrombotic medications for sec­ondary prevention of thromboembolic events; however, oral anti–thrombotics may worsen intracranial hemorrhage due to head trauma. Bleeding that occurs in patients taking anticoagulants can be neutral­ized with a prothrombin complex concentrate (PCC) in the case of warfarin or with idarucizumab in the case of dabigatran, a direct–acting oral anticoagulant. In addition, andexanet alfa has recently be­come available to neutralize factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). We reviewed a case of traumatic intra­cranial hemorrhage in a patient taking Xa inhibitors and discuss the efficacy of this drug.