Apixaban is a direct oral anticoagulant that inhibits factor Xa. Our objective was to examine the effect of apixaban on perioperative transfusion requirements in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.

Quaternary children’s hospital.

Children with congenital or acquired heart disease who received apixaban less than 3 days prior to a cardiac surgical procedure on cardiopulmonary bypass from 2021 to 2023.

A retrospective review.

Forty-three patients with recent apixaban use (median = 2 doses held) were compared to 172 propensity-matched controls. In the entire cohort, 81% of procedures were urgent or emergent, and 30% were reoperative sternotomies. Patients on apixaban received a greater volume of red cell salvage intraoperatively (20.6 v 12.9 mL/kg, p = 0.041). There was no significant difference in the volume of nonautologous blood products transfused intraoperatively between the 2 groups. In the first 24 hours postoperatively, more apixaban patients received a transfusion of packed red blood cells and fresh-frozen plasma. Between the 2 groups, there was no statistically significant difference in the rate of emergent reexploration after the surgery or death within 7 days of operation.

Recent apixaban use in children undergoing cardiac surgery was associated with increased intraoperative transfusion of salvaged red cells. The recent use of apixaban does not appreciably increase the perioperative transfusion requirements of pediatric patients undergoing cardiac surgery, including those undergoing emergent procedures.