There Is No Comparison: Peri-Procedural Bridging in VTE and Reversal of Factor Xa Inhibitors with Andexanet Alfa


Christopher Giuliano and Sean McConachie, both Internal Medicine clinical pharmacists, host this week’s episode on The Rounds Table.  This week they share articles on peri-procedural bridging in patients with venous thromboembolism and the reversal of factor Xa inhibitors with andexanet alfa.

Bridging is commonly performed for interruption of vitamin K antagonists in the peri-procedural setting.  The BRIDGE study found that forgoing bridging was non-inferior to bridging in the prevention of clots in intermediate risk atrial fibrillation patients.  What about in the setting of venous thromboembolism?  Chris shares an article on the incidence of recurrent venous thromboembolism when bridging warfarin with heparin peri-procedurally versus without bridging.

Direct oral anticoagulants (DOACs) have revolutionized management of atrial fibrillation and venous thromboembolism.  However, acute major bleeding episodes in patients on factor Xa inhibitors is challenging due to the lack of specific reversal agents.  Andexanet alfa is a recombinant inactive formulation of factor Xa.  Sean shares an article on the efficacy of andexanet alfa used in patients experiencing major bleeding who present to the Emergency Department after taking Factor Xa inhibitors.

Finally, The Good Stuff segment. Chris discusses the effectiveness of melatonin in the prevention of delirium in the intensive care unit.  Sean shares a novel called ‘Moonwalking with Einstein,’ a nonfictional piece on a journalist who becomes the winner of the U.S. Memory Championship and his journey in building his memory.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Christopher Giuliano @ChristopherGiu9.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. Periprocedural Bridging in VTE: https://www.ncbi.nlm.nih.gov/pubmed/30659809

2. Andexanet Alfa: https://www.nejm.org/doi/full/10.1056/NEJMoa1814051

Good Stuff

1. Melatonin in the ICU: https://doi.org/10.1002/phar.2222

2. Moonwalking with Einstein: https://www.amazon.com/Moonwalking-Einstein-Science-Remembering-Everything/dp/0143120530

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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