First use of andexanet alfa in the management of massive delayed hemothorax

Miroslaw Kozlowski; Julia Antkiewicz; Anna Choroszewska; Krystian Czolpinski; Pawel Niemynski

doi:10.4103/tjem.tjem_25_25

Miroslaw Kozlowski¹, Julia Antkiewicz², Anna Choroszewska², Krystian Czolpinski², Pawel Niemynski¹

¹Department of Thoracic Surgery, Medical University of Bialystok, Białystok, Poland
²Department of Thoracic Surgery, Students’ Scientific Group, Medical University of Bialystok, Białystok, Poland

Keywords: Andexanet alfa, delayed hemothorax, massive hemothorax

Abstract

In emergency medicine practice, massive hemothorax represents a life threatening condition in patients with comorbidities. We present the case of a 75 year old female patient with a massive delayed hemothorax, which developed following a chest injury sustained during a low height fall. The patient had been on long term rivaroxaban, a direct oral anticoagulant, due to underlying comorbid conditions. To reverse the anticoagulant effect, andexanet alfa was administered, followed by the placement of chest drainage. After evacuating the bloody pleural effusion from the pleural cavity, full lung reexpansion was achieved, with only minimal residual drainage within an hour. Following drainage removal, the patient was subsequently discharged without any complications. After follow up, the patient remained in good condition. This case demonstrates that andexanet alfa can be an effective reversal agent in life threatening cases of massive delayed hemothorax.

How to cite this article: Kozlowski M, Antkiewicz J, Choroszewska A, Czolpinski K, Niemynski P. First use of andexanet alfa in the management of massive delayed hemothorax. Turk J Emerg Med 2026;26:71-4.