title: Factor Eight Inhibitor Bypassing Agent (FEIBA) for Reversal of Target-Specific Oral Anticoagulants in Life-Threatening Intracranial Bleeding.
abstract: BACKGROUND
  As increasing number of patients present to emergency departments with life threatening hemorrhages, particularly intracranial hemorrhage on anticoagulation physicians must be cognizant of the limitations of the available reversal options. Based upon the available literature, our institution formulated a reversal algorithm for patients with life-threatening bleeding on factor Xa inhibitors by administering factor eight inhibitor bypassing agent (FEIBA) 20 units/kg.
  
  
  METHODS
  A retrospective chart review was performed to include all patients who received FEIBA per institutional protocol. This case series excluded patients who received FEIBA for reversal of dabigatran. Pre and post FEIBA CT scans were compared for changes. Finally, patients were stratified by estimated mortality rates calculated based on pre-intervention characteristics via published risk models.
  
  
  RESULTS
  Thirteen patients were initially included in this study yet two patients were excluded because they were on dabigatran. Fifty-five percent of patients demonstrated stable ICH on CT scan after FEIBA administration while thirty-six percent showed worsening scans. Two patients developed thrombotic events after FEIBA administration.
  
  
  CONCLUSIONS
  FEIBA is a treatment option in patients on a TSOA with acute intracranial hemorrhage with evidence of at least partial pharmacologic reversal of their anticoagulation status. There does not appear to be any major risk of thromboembolic complications associated with FEIBA. Much larger study sizes will be necessary to establish statically significant clinical efficacy for FEIBA use in this patient population. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency medicine physicians are first-line caretakers for patients with life threatening intracranial hemorrhages whether spontaneous or traumatic. FEIBA is a potentially safe option to reverse TSOA in this patient population.
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: Gordon
authors.initials: G
authors.lastname: Mao
authors.affiliation: Department of Pharmacy, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: Lauren
authors.initials: L
authors.lastname: King
authors.affiliation: Department of Pharmacy, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: Sarah
authors.initials: S
authors.lastname: Young
authors.affiliation: Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: Richard
authors.initials: R
authors.lastname: Kaplan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000458:organization & administration; D065427:Factor Xa Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019934:International Normalized Ratio / Q000379:methods; D020300:Intracranial Hemorrhages / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D011728:Pyridones / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000037:antagonists & inhibitors / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban
keywords: FEIBA; anti-xa inhibitor; anticoagulation; apixaban; dabigatran; intracranial hemorrhage; life-threatening bleeding; reversal; rivaroxaban; target-specific oral anticoagulants