{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:30:12Z","timestamp":1763166612935,"version":"3.45.0"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"06","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"vor","delay-in-days":158,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aorta (Stamford)"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background Direct oral anticoagulants (DOACs) are a commonly used class of anti-coagulants that may complicate surgical management of acute Type A aortic dissection (ATAAD).<\/jats:p>\n                  <jats:p>Methods\u2003Surgical management and clinical courses were described for patients who presented to our institution with ATAAD while taking DOACs, after FDA approval of the two currently available reversal agents. A thorough literature review was completed for cases of administration of DOAC reversal agents in ATAAD.<\/jats:p>\n                  <jats:p>Results\u2003The only patient treated with andexanet-alfa had heparin insensitivity while on cardiopulmonary bypass. Four other patients were successfully managed with a combination of surgical delay and factor repletion.<\/jats:p>\n                  <jats:p>Conclusion\u2003This case series demonstrates that preoperative management of DOACs in patients with ATAAD may employ factor repletion with success. Literature review demonstrated a safety signal for heparin insensitivity or pump thrombosis when andexanet-alfa was administered before or while on cardiopulmonary bypass or extracorporeal membrane oxygenation. Our institutional clinical practice guidelines recommend against administration of andexanet-alfa within 4 to 6\u2009hours before heparinization for surgery in ATAAD but recommend considering andexanet-alfa administration when there is life-threatening bleeding after heparin reversal that is thought to be due to Xa-inhibition with laboratory evidence of elevated anti-Xa activity.<\/jats:p>","DOI":"10.1055\/a-2542-4290","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T19:00:47Z","timestamp":1746730847000},"page":"131-137","source":"Crossref","is-referenced-by-count":0,"title":["Management of Direct Oral Anticoagulants in Acute Type A Aortic Dissection"],"prefix":"10.1055","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-3123","authenticated-orcid":false,"given":"Robert","family":"Semco","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thais","family":"Faggion Vinholo","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jake","family":"Awtry","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asishana","family":"Osho","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim","family":"de la Cruz","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0250-9738","authenticated-orcid":false,"given":"Ashraf A.","family":"Sabe","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"ezad340","DOI":"10.1093\/ejcts\/ezad340","article-title":"Optimal management of cardiac surgery patients using direct oral anticoagulants: recommendations for clinical practice","volume":"64","author":"S Heuts","year":"2023","journal-title":"Eur J Cardiothorac Surg"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"3030","DOI":"10.21037\/jtd-22-428","article-title":"Management of perioperative bleeding risk in patients on antithrombotic 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