Table 8 Anticoagulation reversal agents
Target agent | Reversal agent | Reversal agent mechanism of action | Dosing |
|---|---|---|---|
Vitamin K antagonists | 3 factor or 4 factor prothrombin complex (PCC) | Replacing factors II, IX, X, and VII (4-factor PCC); protein C, S, and Z in other products | 25–50 U/kg intravenous |
Factor Xa inhibitors, heparin, low-molecular weight heparin (LMWH), and fondaparinux | Andexanet alfa | Recombinant variant of human factor Xa that competes with native factor Xa for binding of rivaroxaban, apixaban, and edoxaban, and the heparin-, low-molecular weight heparin-, and fondaparinux-antithrombin complex | 400 mg intravenous bolus followed by intravenous infusion of 480 mg over 2 h for reversal of apixaban or rivaroxaban if > 7 h previously 800 mg followed by an infusion of 960 mg over 2 h for those taking rivaroxaban or rivaroxaban if ≤ 7 h previously or edoxaban |
Dabigatran | Idarucizumab | Noncompetitive, specific, and direct binding of dabigatran | 5 g intravenous bolus |
Antiplatelets | Platelets or desmopressin | Desmopressin increases release of von Willebrand factor in platelets thus increasing factor VIII availability for clotting | 0.4 mcg/kg Uremia, 0.3 mcg/kg |