Andexanet alfaを術前投与しヘパリン抵抗性に苦慮した1例

Heparin Resistance After Administration of Andexanet Alfa：Report of a Case

はじめに　近年，直接経口抗凝固薬（DOAC）の使用増加に伴いこれらの内服患者における緊急開心術も増加している．

The management of patients on direct oral anticoagulants （DOACs） who require an emergency cardiac surgery has been disputed in Japan. Recently, the use of andexanet alfa as an antidote for apixaban and rivaroxaban, is approved in the setting of life-threating or uncontrollable major bleeding. However, the efficacy and safety of andexanet alfa have been investigated. We report a case of 72-year-old man taking rivaroxaban who required the emergency coronary artery bypass grafting. He received andexanet alfa prior to the operation. Heparin resistance was noted before starting cardiopulmonary bypass. Consideration should be given to the use of andexanet alfa before or during cardiopulmonary bypass.