title: Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation.
abstract: We report the case of an 82-year-old man in whom hemorrhagic pericardial effusion occurred one week after pacemaker implantation, while he was taking apixaban. Few therapies exist for reversing the anti-Xa effect of apixaban. To reverse anticoagulation, our patient underwent plasma exchange, which facilitated pericardiocentesis and prevented possible surgical intervention. To our knowledge, this is the first report of the use of plasmapheresis to reverse the anticoagulant effect of apixaban.
authors.forename: Wilson W
authors.initials: WW
authors.lastname: Lam
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Reyes
authors.forename: John J
authors.initials: JJ
authors.lastname: Seger
mesh_terms: D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D002305:Cardiac Tamponade / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D004452:Echocardiography; D065427:Factor Xa Inhibitors / Q000009:adverse effects* / Q000097:blood; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D010490:Pericardial Effusion / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D020519:Pericardiocentesis; D010951:Plasma Exchange; D011720:Pyrazoles / Q000009:adverse effects* / Q000097:blood; D011728:Pyridones / Q000009:adverse effects* / Q000097:blood; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban
keywords: Anticoagulants/administration & dosage/adverse effects/antagonists & inhibitors/therapeutic use; apixaban; atrial fibrillation/complications/drug therapy; factor Xa inhibitors; pacemaker, artificial/adverse effects; plasma exchange; risk factors; stroke/prevention & control; treatment outcome; warfarin/therapeutic use