Table 2.
Anti-Xa Levels, Clinical Setting, and Administration of Reversal Agents
| Patient | Preadmission Oral FXaI | Clinical Setting | Anti-Xa Assay Result, ng/mL | Reversal Agent Received | Disposition at Discharge |
|---|---|---|---|---|---|
| 1 | API | ICH | 93 | aPCC (1,932 units) | SNF |
| 2 | API | ICH | 108 | No | Home |
| 3 | RIV | Right forearm swelling with hematoma; initial concern for compartment syndrome with need for surgical intervention | 59 | No | Home |
| 4 | RIV | Sepsis secondary to sacral abscess requiring surgical intervention | 37 | No | Deceased |
| 5 | API | Incarcerated hernia requiring surgical intervention | 86 | aPCC (1,932 units) | Home |
| 6 | RIV | ICH; anti-Xa level obtained 46 minutes after PCC administration at outside hospital | 182 | PCCb (2,215 units) | SNF |
| 7 | API | ICH | 384 | aPCC (2,712 units) | SNF |
| 8 | API | GIB | 156 | aPCC (2,495 units) | Home |
| 9 | RIV | Monitoring only; received tPA before arrival while also on reported rivaroxaban; last dose of rivaroxaban was reported to be approximately 26 hours before the anti-Xa level was obtained | <20 | No | Home |
| 10 | API | ICH; anti-Xa level obtained 260 minutes after PCC administration at outside hospital | 120 | PCCb (2,495 units) | Deceased |
| 11 | API | Anti-Xa level obtained at initial patient presentation; concern for ICH, but CT scan of head was negative for ICH | 107 | No | Home |
| 12 | Nonea | Patient not on anticoagulation, anti-Xa level obtained because the patient was not able to provide information; known history of PE | <20 | No | SNF |
| 13 | RIV | ICH | 114 | aPCC (2,089 units) | Deceased |
| 14 | RIV | GIB | 77 | No | SNF |
| 15 | RIV | GIB | 80 | No | Home |
| 16 | Nonea | Patient not on anticoagulation, anti-Xa level obtained because the patient was not able to provide information; known history of PE | <20 | No | SNF |
| 17 | RIV | Large bowel obstruction; anti-Xa level collected in the event that the patient would require emergent reversal for surgical intervention | 330 | aPCC (3,333 units) | Home |
| 18 | API | Perforated colitis and developing abscess; anti-Xa level determined in the event that the patient would require emergent reversal for surgical intervention | >550 | No | Deceased |
| 19 | API | ICH | 256 | No | Home |
| 20 | API | ICH | 60 | aPCC (2,235 units) | SNF |
| 21 | API | Acute cholecystitis requiring surgical intervention | 42 | aPCC (2,222 units) | Home |
| 22 | RIV | GIB | 231 | No | Home |
| 23 | RIV | Epidural hematoma with cord compression requiring surgical intervention | >450 | aPCC (3,333 units) | SNF |
| 24 | API | ICH; initial anti-Xa level before aPCC administration resulted in lab error and additional level was determined 92 minutes after administration; aPCC was given before results as to not delay reversal | 23 | aPCCb (4,176 units) | SNF |
| 25 | RIV | ICH; received PCC at an outside hospital and the anti-Xa assay was performed 71 minutes after PCC administration; aPCC was given after the anti-Xa level was obtained based on clinical course | 306 | PCCb (1,500 units), aPCC (1,962 units) | SNF |
| 26 | API | ICH; left posterior cerebral artery stroke with hemorrhagic transformation; per report, had not taken apixaban for 2 days | <20 | No | SNF |
| 27 | RIV | ICH | 46 | aPCC (2,943 units) | Home |
| 28 | RIV | ICH | 49 | No | SNF |
| 29 | API | ICH | 133 | No | SNF |
| 30 | Nonea | Trauma patient unable to provide history; previously on apixaban per report | <20 | No | SNF |
Abbreviations: aPCC, activated prothrombin complex concentrate; API, apixaban; CT, computed tomography; FXaI, factor Xa inhibitor; GIB, gastrointestinal bleed; ICH, intracranial hemorrhage; PCC, prothrombin complex concentrate; PE, pulmonary embolism; RIV, rivaroxaban; SNF, skilled nursing facility; tPA, tissue plasminogen activator; Xa, factor Xa.
aRivaroxaban anti-Xa levels were obtained in all patients who were not taking an oral factor Xa inhibitor before admission.
bReversal agent was administered before collection of a sample for an anti-Xa assay.