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Table 8 Anticoagulation reversal agents

From: Subarachnoid hemorrhage in the emergency department

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
  1. g Grams, mcg Micrograms, kg Kilogram, mg Milligram, h Hour, U Units