{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:56:34Z","timestamp":1783472194341,"version":"3.55.0"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,7,18]],"date-time":"2019-07-18T00:00:00Z","timestamp":1563408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>The authors describe a case of unfractionated heparin (<jats:styled-content style=\"fixed-case\">UFH<\/jats:styled-content>) unresponsiveness in the operating room secondary to reversal of rivaroxaban with coagulation factor Xa (recombinant) inactivated\u2010zhzo (andexanet alfa). A 70\u2010year\u2010old man with a known 4.5\u2010 to 5.0\u2010cm abdominal aortic aneurysm and atrial fibrillation managed with rivaroxaban presented with severe right\u2010sided flank pain radiating to the left side of his abdomen. Computed tomography\u2010angiography on arrival demonstrated a left\u00a0retroperitoneal hematoma and a suspected ruptured abdominal aortic aneurysm. He received andexanet alfa to reverse rivaroxaban prior to an emergent endovascular aneurysm repair. During surgery, he received a total of 14,000 units (167\u00a0units\/kg) of <jats:styled-content style=\"fixed-case\">UFH<\/jats:styled-content> with minimal changes in activated clotting time (132\u2013144\u00a0sec; baseline 135\u00a0sec [reference range 74\u2013137\u00a0sec]). This case highlights the potential complications of using <jats:styled-content style=\"fixed-case\">UFH<\/jats:styled-content> anticoagulation following reversal of factor Xa inhibitors with andexanet alfa and underscores the importance of peri\u2010procedural anticoagulation planning. For patients who require intra\u2010operative anticoagulation, providers\u00a0should consider anticoagulation reversal with prothrombin complex concentrate instead of andexanet alfa or administration of a parenteral direct thrombin inhibitor, such as argatroban or bivalirudin during the surgical procedure.<\/jats:p>","DOI":"10.1002\/phar.2306","type":"journal-article","created":{"date-parts":[[2019,6,28]],"date-time":"2019-06-28T12:54:37Z","timestamp":1561726477000},"page":"861-865","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Intraoperative Unfractionated Heparin Unresponsiveness during Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm following Administration of Andexanet Alfa for the Reversal of Rivaroxaban"],"prefix":"10.1002","volume":"39","author":[{"given":"Ifeoma Mary","family":"Eche","sequence":"first","affiliation":[{"name":"Department of Pharmacy Beth Israel Deaconess Medical Center Boston 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