Transfusion recipients had more cardiovascular events and deaths and a longer length of stay. In multivariable analysis controlling for additional risk factors, only mortality risk was significantly elevated with platelet transfusion. Rebleeding risk was not significantly different between groups.
These findings suggest that platelet transfusions provide no benefit in patients with GIB taking antiplatelet drugs.
Source: Zakko L, Rustagi T, Douglas M, et al. No benefit from platelet transfusion for gastrointestinal bleeding in patients taking antiplatelet agents. Clin Gastroenterol Hepatol. 2016; Jul 25; http://www.ncbi.nlm.nih.gov/pubmed/27464591
Factor Xa Reversal Agent Shows Rapid Effectiveness
Updated results of the ANNEXA-4 trial showed that andexanet alfa, a factor Xa inhibitor antidote, worked quickly and was well tolerated in reversing acute anticoagulant-related bleeding in 67 study subjects.
The patients required emergency reversal of acute bleeding after receiving the direct factor Xa inhibitors apixaban, rivaroxaban, or edoxaban, or an indirect inhibitor (enoxaparin) within the preceding 18 hours. The primary bleeding sites were gastrointestinal (49%) and intracranial (42%).
The drug was administered in an immediate bolus over 15 to 30 minutes, then by infusion for 2 hours. Dosing was based on which factor Xa inhibitor the patient was taking and when it was received.
Researchers observed an 89% decrease in anti–factor Xa activity within a half hour in patients on rivaroxaban (n=26) and a 93% reduction for patients on apixaban (n=20).
They rated clinical hemostatic efficacy as good to excellent in 79% of patients at 12 hours overall. Thrombotic events occurred within 3 days of andexanet in four patients (6%) and by 30 days in 12 (18%). Eighteen patients (27%) restarted anticoagulation by 30 days. Ten deaths (15%) occurred within 30 days, six of them attributed to cardiovascular causes.
Connolly SJ, Milling TJ, Eikelboom JW, et al. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. New England J Med, Published online August 30, 2016.