Management of apixaban-associated subdural hematoma: a case report on the use of factor eight inhibitor bypassing activity.
OBJECTIVE
We report a case of a patient receiving apixaban who developed a spontaneous subdural hematoma and declining mental status that improved after administration of a single dose of factor eight inhibitor bypassing activity.


METHODS
Case report.


METHODS
Comprehensive Stroke Center, Neurocritical Care Unit.


METHODS
A 76-year-old man presented to an outside facility with a chief complaint of headache and pain behind his right eye. A CT scan of his head revealed a subdural hematoma. The patient was transferred to our facility with worsening clinical status.


METHODS
After a confirmatory cranial CT scan revealed a worsening subdural hematoma with midline shift, a single dose of factor VIII inhibitor bypassing activity (25 U/kg) was administered.


RESULTS
Coagulation tests following the administration of factor VIII inhibitor bypassing activity and a follow-up CT scan confirmed hemostasis. The patient was discharged home with no focal deficits.


CONCLUSIONS
Factor VIII inhibitor bypassing activity may be a viable, nonspecific reversal agent for life-threatening bleeding associated with apixaban.
1Department of Clinical Pharmacy, College of Pharmacy, The University of Tennessee Health Science Center, Knoxville, TN. 2Department of Anesthesiology, The University of Tennessee Graduate School of Medicine, Knoxville, TN.
Derrick R
DR
Rinehart
Nicholas R
NR
Lockhart
Leslie A
LA
Hamilton
J Russell
JR
Langdon
A Shaun
AS
Rowe
D000368:Aged; D065427:Factor Xa Inhibitors / Q000009:adverse effects*; D006408:Hematoma, Subdural / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011720:Pyrazoles / Q000009:adverse effects*; D011728:Pyridones / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban