{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T14:05:55Z","timestamp":1776434755721,"version":"3.51.2"},"reference-count":11,"publisher":"Texas Heart Institute Journal","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:p>Direct oral anticoagulants, which include the factor Xa inhibitor rivaroxaban, have some advantages over vitamin K antagonists in regard to stroke prevention in patients with atrial fibrillation. However, no antidotes to reverse the effect of oral anticoagulants are commercially available, which can complicate treating patients in whom reversal is urgent. We faced this challenge in a kidney transplant candidate, a 65-year-old man with end-stage renal disease who had been taking rivaroxaban for paroxysmal atrial fibrillation. When a deceased-donor kidney became available, we needed to rapidly reduce the patient's bleeding risk, while minimizing the cold ischemic time of the donor kidney. Therefore, we decided to take an experimental approach and perform therapeutic plasma exchange. The patient's plasma anti-factor Xa level decreased from 0.4 IU\/mL immediately before treatment to 0.21 IU\/mL afterward, indicating that rivaroxaban had been actively removed from circulation. Waste fluid showed significant anti-Xa activity, indicating that the risk of rebound anticoagulation had been mitigated. The patient subsequently underwent successful kidney transplantation.<\/jats:p>\n        <jats:p>To our knowledge, this is the first report of therapeutic plasma exchange to reverse the effects of rivaroxaban in a patient undergoing urgent surgery. This treatment may also be suitable for patients who have life-threatening, large-volume bleeding, especially in the presence of substantial kidney or liver dysfunction.<\/jats:p>","DOI":"10.14503\/thij-17-6229","type":"journal-article","created":{"date-parts":[[2018,5,4]],"date-time":"2018-05-04T20:01:28Z","timestamp":1525464088000},"page":"96-98","source":"Crossref","is-referenced-by-count":6,"title":["Therapeutic Plasma Exchange for Urgent Rivaroxaban Reversal"],"prefix":"10.14503","volume":"45","author":[{"given":"Varun","family":"Kumar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Allencherril","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur","family":"Bracey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice J.","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilson W.","family":"Lam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"5628","reference":[{"issue":"6","key":"i1526-6702-45-2-96-b1","series-title":"Curr Opin Hematol","first-page":"552","article-title":"Novel thrombin and factor Xa inhibitors: challenges to reversal of their anticoagulation effects","volume":"20","year":"2013","unstructured":"Yates\n              S\n            , SarodeR.\n          Novel thrombin and factor Xa inhibitors: challenges to reversal of their anticoagulation effects. Curr Opin Hematol2013;20(6):552\u20137."},{"issue":"5","key":"i1526-6702-45-2-96-b2","series-title":"Ther Adv Hematol","first-page":"309","article-title":"Advances in oral anticoagulation treatment: the safety and efficacy of rivaroxaban in the prevention and treatment of thromboembolism","volume":"3","year":"2012","unstructured":"Turpie\n              AG.\n            \n          \n          Advances in oral anticoagulation treatment: the safety and efficacy of rivaroxaban in the prevention and treatment of thromboembolism. Ther Adv Hematol2012;3(5):309\u201323."},{"key":"i1526-6702-45-2-96-b3","series-title":"Xarelto (rivaroxaban) tablets, for oral use [package insert]","unstructured":"Xarelto (rivaroxaban) tablets, for oral use [package insert]. Janssen Pharmaceuticals, Inc., a Johnson & Johnson company. Available at: https:\/\/www.xareltohcp.com\/shared\/product\/xarelto\/prescribing-information.pdf [revised 2017 Oct]."},{"issue":"11","key":"i1526-6702-45-2-96-b4","series-title":"J Am Coll Cardiol","first-page":"1128","article-title":"Laboratory measurement of the anticoagulant activity of the non-vitamin K oral anticoagulants","volume":"64","year":"2014","unstructured":"Cuker\n              A\n            , SiegalDM, CrowtherMA, GarciaDA.\n          Laboratory measurement of the anticoagulant activity of the non-vitamin K oral anticoagulants. J Am Coll Cardiol2014;64(11):1128\u201339."},{"issue":"2","key":"i1526-6702-45-2-96-b5","series-title":"Transfus Apher Sci","first-page":"212","article-title":"Can an anti-Xa assay for low-molecular-weight heparin be used to assess the presence of rivaroxaban?","volume":"55","year":"2016","unstructured":"Yates\n              SG\n            , SmithS, TharpeW, ShenYM, SarodeR.\n          Can an anti-Xa assay for low-molecular-weight heparin be used to assess the presence of rivaroxaban?\n          Transfus Apher Sci\n          2016;55 (2):212\u20135."},{"key":"i1526-6702-45-2-96-b6","series-title":"Blood","first-page":"3636","article-title":"A phase 2 randomized, double-blind, placebo-controlled trial demonstrating reversal of rivaroxaban-induced anticoagulation in healthy subjects by andexanet alfa (PRT064445), an antidote for fXa inhibitors [abstract]","volume":"122","year":"2013","unstructured":"Crowther\n              M\n            , VandanaM, KittM, LuG, ConleyPB, HollenbachS, \n          et al. A phase 2 randomized, double-blind, placebo-controlled trial demonstrating reversal of rivaroxaban-induced anticoagulation in healthy subjects by andexanet alfa (PRT064445), an antidote for fXa inhibitors [abstract]. Blood2013;122:3636. Available at: http:\/\/www.bloodjournal.org\/content\/122\/21\/3636."},{"issue":"12","key":"i1526-6702-45-2-96-b7","series-title":"N Engl J Med","first-page":"1131","article-title":"Andexanet alfa for acute major bleeding associated with factor Xa inhibitors","volume":"375","year":"2016","unstructured":"Connolly\n              SJ\n            , MillingTJJr, EikelboomJW, GibsonCM, CurnutteJT, GoldA, \n          et al. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med2016;375(12):1131\u201341."},{"issue":"25","key":"i1526-6702-45-2-96-b8","series-title":"N Engl J Med","first-page":"2413","article-title":"Andexanet alfa for the reversal of factor Xa inhibitor activity","volume":"373","year":"2015","unstructured":"Siegal\n              DM\n            , CurnutteJT, ConnollySJ, LuG, ConleyPB, WiensBL, \n          et al. Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med2015;373(25):2413\u201324."},{"issue":"3","key":"i1526-6702-45-2-96-b9","series-title":"Arterioscler Thromb Vasc Biol","first-page":"376","article-title":"Rivaroxaban: a new oral factor Xa inhibitor","volume":"30","year":"2010","unstructured":"Perzborn\n              E\n            , RoehrigS, StraubA, KubitzaD, MueckW, LauxV.\n          Rivaroxaban: a new oral factor Xa inhibitor. Arterioscler Thromb Vasc Biol2010;30(3):376\u201381."},{"issue":"10","key":"i1526-6702-45-2-96-b10","series-title":"N Engl J Med","first-page":"883","article-title":"Rivaroxaban versus warfarin in nonvalvular atrial fibrillation","volume":"365","year":"2011","unstructured":"Patel\n              MR\n            , MahaffeyKW, GargJ, PanG, SingerDE, HackeW, \n          et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med2011;365(10):883\u201391."},{"issue":"4","key":"i1526-6702-45-2-96-b11","series-title":"Tex Heart Inst J","first-page":"377","article-title":"Plasma exchange for urgent apixaban reversal in a case of hemorrhagic tamponade after pacemaker implantation","volume":"42","year":"2015","unstructured":"Lam\n              WW\n            , ReyesMA, SegerJJ.\n          Plasma exchange for urgent apixaban reversal in a case of hemorrhagic tamponade after pacemaker implantation. Tex Heart Inst J2015;42(4):377\u201380."}],"container-title":["Texas Heart Institute Journal"],"original-title":[],"link":[{"URL":"https:\/\/thij.kglmeridian.com\/view\/journals\/thij\/45\/2\/article-p96.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/thij\/article-pdf\/45\/2\/96\/1967408\/thij-17-6229.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thij.kglmeridian.com\/downloadpdf\/journals\/thij\/45\/2\/article-p96.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thij.kglmeridian.com\/downloadpdf\/journals\/thij\/45\/2\/article-p96.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T15:36:34Z","timestamp":1730993794000},"score":1,"resource":{"primary":{"URL":"https:\/\/thij.kglmeridian.com\/view\/journals\/thij\/45\/2\/article-p96.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4]]},"references-count":11,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.14503\/thij-17-6229","relation":{},"ISSN":["0730-2347","1526-6702"],"issn-type":[{"value":"0730-2347","type":"print"},{"value":"1526-6702","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4]]}}}