Case Report: Isolated homonymous hemianopia after reversal of anticoagulation with andexanet alfa.

PURPOSE: Clinical scoring systems have been developed (e.g., CHA2DS2-VASc and HAS-BLED) to aid in the perioperative management of anticoagulation therapy. The decision to continue, modify, or stop anticoagulation prior to surgical procedures requires multidisciplinary input and an individualised plan. Decisions both to continue or reverse anticoagulation can cause visual loss. OBSERVATIONS: We report the use of andexanet alfa (recombinant inactive factor Xa) as a reversal agent for anticoagulation in atrial fibrillation after surgical bleeding, which resulted in secondary homonymous hemianopsia and ischemic infarct. CONCLUSION AND IMPORTANCE: Stroke is a major risk factor for atrial fibrillation, and anticoagulation in specific settings is evidence-based. Anticoagulation, however, increases the risk of haemorrhage and may require the use of a reversal agent (e.g., Andexanet alfa) in cases of severe bleeding. Unfortunately, reversal of anticoagulation in this setting can lead to an ischemic stroke and visual loss.