{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T16:26:09Z","timestamp":1764433569513,"version":"build-2065373602"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T00:00:00Z","timestamp":1719014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["eJHaem"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Andexanet alfa is a recombinant, modified factor Xa (FXa) molecule that is used for the reversal of the anticoagulant effect of oral anti\u2010FXa anticoagulants in patients with major haemorrhage. Here, we present a case of an 85\u2010year\u2010old man taking rivaroxaban for atrial fibrillation, who presented with an acute, upper gastrointestinal bleed. He was stabilised with red cell transfusion and then received a 400\u00a0mg bolus of andexanet alfa. Within minutes of this, he developed chest tightness, shortness of breath, ischaemic electrocardiographic changes and then cardiac arrest from which he could not be resuscitated. The onset of symptoms was clearly temporally related to andexanet alfa administration and the differential diagnosis includes anaphylaxis with Kounis syndrome, or myocardial infarction. Although infusion site reactions have been reported and are relatively common, this is to date the first case of a fatal drug reaction andexanet alfa. This knowledge can be factored into physicians\u2019 risk\u2013benefit decisions when treating patients with oral anti\u2010FXa anticoagulant\u2010associated major haemorrhage.<\/jats:p>","DOI":"10.1002\/jha2.959","type":"journal-article","created":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T07:03:40Z","timestamp":1719039820000},"page":"829-832","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Fatal drug reaction to andexanet alfa: a case report"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2738-6236","authenticated-orcid":false,"given":"Richard J.","family":"Buka","sequence":"first","affiliation":[{"name":"Institute of Cardiovascular Sciences University of Birmingham  Birmingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mamidipudi T.","family":"Krishna","sequence":"additional","affiliation":[{"name":"Institute of Immunology and Immunotherapy University of Birmingham  Birmingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5279-6889","authenticated-orcid":false,"given":"David J.","family":"Sutton","sequence":"additional","affiliation":[{"name":"Clinical Haematology University Hospitals North Midlands NHS Trust  Stoke\u2010on\u2010Trent UK"},{"name":"Clinical Haematology Mid Cheshire Hospitals NHS Foundation Trust  Crewe UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,6,22]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2313040"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814051"},{"key":"e_1_2_13_4_1","unstructured":"US Food and Drug Administration.ANDEXXA (coagulation factor Xa (recombinant) inactivated\u2010zhzo) [Internet]. [cited 2023 Dec 11]. Available from:https:\/\/www.fda.gov\/vaccines\u2010blood\u2010biologics\/cellular\u2010gene\u2010therapy\u2010products\/andexxa"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.waojou.2020.100472"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200309000-00007"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2017.06.021"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.00494"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/cei.12424"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2016-0010"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2222.2007.02804.x"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11882-014-0450-8"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40521-023-00349-2"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1510991"},{"key":"e_1_2_13_15_1","unstructured":"European Medicines Agency.Summary of product characteristics: andexanet alfa [Internet]. [cited 2023 Dec 11]. Available from:https:\/\/www.ema.europa.eu\/en\/documents\/product\u2010information\/ondexxya\u2010epar\u2010product\u2010information_en.pdf"},{"key":"e_1_2_13_16_1","unstructured":"Swiss Agency for Therapeutic Products.Swiss public assessment report. ONDEXXYA [Internet].2019[cited 2024 Jan 30]. Available from:https:\/\/www.swissmedic.ch\/dam\/swissmedic\/fr\/dokumente\/zulassung\/swisspar\/67759\u2010ondexxya\u201001\u2010swisspar\u201020210119.pdf.download.pdf\/SwissPAR_Ondexxya.pdf"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2017.174037"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13768"}],"container-title":["eJHaem"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jha2.959","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T02:09:50Z","timestamp":1760407790000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jha2.959"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,22]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1002\/jha2.959"],"URL":"https:\/\/doi.org\/10.1002\/jha2.959","archive":["Portico"],"relation":{},"ISSN":["2688-6146","2688-6146"],"issn-type":[{"type":"print","value":"2688-6146"},{"type":"electronic","value":"2688-6146"}],"subject":[],"published":{"date-parts":[[2024,6,22]]},"assertion":[{"value":"2024-04-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}