Presentation
Time is Brain: Apixaban and Rivaroxaban Reversal Strategies for Intracerebral Hemorrhage Requiring Surgery
DescriptionThis session will focus on antithrombotic reversal strategies in patients presenting with an intracerebral hemorrhage on apixaban or rivaroxaban. This session will compare and contrast reversal strategies for patients on a direct oral anticoagulant (DOAC) comparing andexanet alfa to 4F-PCC as well as evaluating different dosing strategies for 4F-PCC including weight based versus fixed dosing. This talk will go in depth evaluating the current literature regarding andexanet alfa versus 4F-PCC for apixaban and rivaroxaban reversal. This session will evaluate outcomes and reversal strategies for patients undergoing a neurosurgical procedure and how that may impact the reversal strategy taking into account the type of surgery, length of surgery and level of anticoagulation present prior to surgery. Given the significant cost of andexanet alfa and pharmacokinetic differences compared to 4F-PCC, discussions regarding addition to formulary, development of an institutional anticoagulation reversal guideline, and education to hospital staff regarding institutional protocols will be discussed. Throughout the session, an interactive case will engage the audience to apply the knowledge they are learning to real life situations that may occur in the hospital setting. Due to the substantial increase in DOAC use in the community, hospitals are seeing an increasing number of patients who present to the ED and ICU setting with an intracerebral hemorrhage on rivaroxaban or apixaban prompting the need for quick, safe, and effective reversal strategies.
Speaker

Event Type
Breakout Session
TimeThursday, October 17th9:55am - 10:15am PDT
LocationHarbor Ballrooms D-I
Clinical Practice
Intracerebral Hemorrhage
Ischemic Stroke
Multimodal Neuromonitoring (invasive/non-invasive)
Nursing Pharmacology
Pharmacist Practice
Stroke
Subarachnoid Hemorrhage
Intermediate
Advanced