title: Emergency neurosurgical care in patients treated with apixaban: report of 2 cases.
abstract: A debate has emerged regarding the safety profile of direct anticoagulants, which are increasingly prescribed for the prevention of thromboembolic events. Despite favorable safety data derived from controlled clinical trials, the absence of specific antidotes for the management of hemorrhagic complications represents a major challenge for emergency physicians. Here, we present the first report on patients treated with the direct factor Xa inhibitor apixaban and conditions requiring urgent neurosurgical intervention (intracerebral hemorrhage, n = 1; subdural hematoma, n = 1). Prothrombin complex concentrates were administered before surgery, and both patients had a favorable postsurgical course without bleeding or thromboembolic complications. Further studies are needed, but this approach seems to be suitable for the emergency management of apixaban-associated intracranial hemorrhage.
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: christopher.beynon@med.uni-heidelberg.de.
authors.forename: Christopher
authors.initials: C
authors.lastname: Beynon
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Potzy
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Unterberg
authors.affiliation: Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Sakowitz
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006408:Hematoma, Subdural / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019635:Neurosurgical Procedures; D011720:Pyrazoles / Q000009:adverse effects*; D011728:Pyridones / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban