CC BY 4.0 · TH Open 2018; 02(03): e346-e349
DOI: 10.1055/s-0038-1672211
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Successful Use of Recombinant Activated Factor VII to Reverse Ticagrelor-Induced Bleeding Risk: A Case Report

Anne Godier
1   Service d'Anesthésie-Réanimation, Fondation Adolphe de Rothschild, Paris, France
2   Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
3   INSERM UMR-S1140, Paris, France
,
Mélanie Dupont
1   Service d'Anesthésie-Réanimation, Fondation Adolphe de Rothschild, Paris, France
,
Jean-Philippe Desilles
4   Département de Neuroradiologie Interventionnelle, Fondation Adolphe de Rothschild, Paris, France
5   Sorbonne Paris Cité, Laboratory of Vascular Translational Science, Université Paris Diderot, Paris, France
6   INSERM UMR 1148, Paris, France
,
Caroline Le Guerinel
7   Département de Neurochirurgie, Fondation Adolphe de Rothschild, Paris, France
,
Guillaume Taylor
1   Service d'Anesthésie-Réanimation, Fondation Adolphe de Rothschild, Paris, France
,
Mathilde Perrin
1   Service d'Anesthésie-Réanimation, Fondation Adolphe de Rothschild, Paris, France
,
Anne-Céline Martin
2   Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
3   INSERM UMR-S1140, Paris, France
8   Service de Cardiologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
,
Pascale Gaussem
2   Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
3   INSERM UMR-S1140, Paris, France
9   Service d'hématologie Biologique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
› Author Affiliations
Further Information

Publication History

09 May 2018

20 August 2018

Publication Date:
27 September 2018 (online)

Abstract

Management of ticagrelor-associated bleeding is challenging, especially in neurosurgery. Platelet transfusion is inefficient and no antidote is currently available. We report here the first case of recombinant activated factor VII (rFVIIa) use to bypass ticagrelor-induced platelet inhibition. A woman treated with ticagrelor and requiring emergent neurosurgery for an intracranial hematoma received preoperative high-dose platelet transfusion and 60 μg/kg rFVIIa. Laboratory monitoring demonstrated that platelet transfusion failed to reverse ticagrelor-induced platelet inhibition while rFVIIa improved hemostasis by shortening the thromboelastometric clotting time. Neurosurgery occurred without any bleeding event but the patient presented with a postoperative pulmonary embolism. In conclusion, rFVIIa may decrease ticagrelor-induced bleeding risk but careful assessment of the benefit-risk balance is warranted before using rFVIIa to reverse ticagrelor effects.