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Andexanet alfa-induced heparin resistance resulted in cardiopulmonary bypass circuit and pericardial thrombosis requiring more than 400,000 units of unfractionated heparin and antithrombin III to overcome. Postoperatively, excessive chest tube output was observed secondary to protracted heparin rebound requiring continuous dosing of protamine. This case demonstrates the significant challenging perioperative, not just intraoperative, hazards associated with intraoperative andexanet alfa use during emergency cardiac surgery with cardiopulmonary bypass.<\/jats:p>","DOI":"10.1177\/02676591241268395","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T14:01:34Z","timestamp":1721916094000},"page":"1045-1048","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative risks associated with administration of andexanet alfa during emergency cardiac surgery with circulatory arrest"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9556-106X","authenticated-orcid":false,"given":"Ajami","family":"Gikandi","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean M.","family":"Connors","sequence":"additional","affiliation":[{"name":"Division of Hematology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph G.","family":"Nabzdyk","sequence":"additional","affiliation":[{"name":"Division of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco A.","family":"Zenati","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,7,25]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814051"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.057844"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1213\/XAA.0000000000001052"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1213\/XAA.0000000000001636"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2020.10.042"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2016003616"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","unstructured":"Levy JH Sniecinski RM Maier CL et al. Finding a common definition of heparin resistance in adult cardiac surgery: communication from the ISTH SSC subcommittee on perioperative and critical care thrombosis and hemostasis. J Thromb Haemost. Epub ahead of print 10 January 2024. 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