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Godier A, Dupont M, Desilles JP, et al. Successful Use of Recombinant Activated Factor VII to Reverse Ticagrelor-Induced Bleeding Risk: A Case Report. TH Open. 2018;2(3):e346-e349doi: 10.1055/s-0038-1672211.
Godier, A., Dupont, M., Desilles, J. P., Le Guerinel, C., Taylor, G., Perrin, M., Martin, A. C., & Gaussem, P. (2018). Successful Use of Recombinant Activated Factor VII to Reverse Ticagrelor-Induced Bleeding Risk: A Case Report. TH open : companion journal to thrombosis and haemostasis, 2(3), e346-e349. https://doi.org/10.1055/s-0038-1672211
Godier, Anne, et al. "Successful Use of Recombinant Activated Factor VII to Reverse Ticagrelor-Induced Bleeding Risk: A Case Report." TH open : companion journal to thrombosis and haemostasis vol. 2,3 (2018): e346-e349. doi: https://doi.org/10.1055/s-0038-1672211
Godier A, Dupont M, Desilles JP, Le Guerinel C, Taylor G, Perrin M, Martin AC, Gaussem P. Successful Use of Recombinant Activated Factor VII to Reverse Ticagrelor-Induced Bleeding Risk: A Case Report. TH Open. 2018 Sep 27;2(3):e346-e349. doi: 10.1055/s-0038-1672211. eCollection 2018 Jul. PMID: 31249959; PMCID: PMC6524896.
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TH Open. 2018 Sep 27;2(3):e346-e349. doi: 10.1055/s-0038-1672211. eCollection 2018 Jul.

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

TH open : companion journal to thrombosis and haemostasis

Anne Godier, Mélanie Dupont, Jean-Philippe Desilles, Caroline Le Guerinel, Guillaume Taylor, Mathilde Perrin, Anne-Céline Martin, Pascale Gaussem

Affiliations

  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.
  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.
  7. Département de Neurochirurgie, Fondation Adolphe de Rothschild, Paris, France.
  8. Service de Cardiologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France.
  9. Service d'hématologie Biologique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.

PMID: 31249959 PMCID: PMC6524896 DOI: 10.1055/s-0038-1672211

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.

Keywords: antithrombotic; platelet transfusion; recombinant activated factor VII; reversal; ticagrelor

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