| Class
|
Anticoagulants
|
Half-life
|
Removed by HD
|
Strategies to reverse or minimize anticoagulant effects
|
| Factor Xa Inhibitor |
Apixaban (Eliquis®) |
8-15 hrs (longer in renal impairment) |
No |
*If ingested within 2 hours, administer activated charcoal *4-factor PCC (Kcentra™)^ **25units/kg—max 2500 units for treatment of documented intracranial hemorrhage **50 units/kg—max 5000 units for all other life-threatening bleeds
|
| 1 |
Edoxaban (Savaysa®) |
10-14 hrs (longer in renal impairment) |
~ 25% |
As above
|
| 1 |
Rivaroxaban (Xarelto®) |
9-13 hrs (longer in renal impairment) |
No |
As above
|
| 1 |
Fondaparinux (Arixtra®) |
17-21 hrs (significantly longer in renal impairment) |
No |
4-factor PCC (Kcentra™)* 50 units/kg—max 5000 units
|
| Direct Thrombin Inhibitor |
Argatroban |
40-50 min |
~ 20% |
Turn off infusion
|
| 1 |
Bivalirudin (Angiomax®) |
25 min (up to 1 hr in severe renal impairment) |
~ 25% |
As above
|
| 1 |
Dabigatran (Pradaxa®) |
14-17 hrs (up to 34 hrs in severe renal impairment) |
~ 65% |
If ingested within 2 hours, administer activated charcoal *Idarucizumab (Praxbind®) 5g IV *For end stage renal disease patient with pre-existing vascular access, consult nephrology to consider dialysis.
|
| Low Molecular Weight Heparin |
Dalteparin (Fragmin®) |
3-5 hrs (longer in renal impairment) |
~ 20% |
*Use protamine for partial neutralization (~60%) *Protamine IV: **< 8 hours since last LMWH dose: Protamine 50 mg **8-12 hours since last LMWH dose: Protamine 25 mg **>12 hours since last LMWH dose: Unlikely useful unless CrCl < 30 mL/min (or 25mg fixed dose)* Dose of protamine for each 100 units dalteparin or 1mg of enoxaparin administered *Obtain baseline anti-Xa activity level *Monitor anti-Xa activity level to confirm reversal
|
| 1 |
Enoxaparin (Lovenox®) |
|
|
As above
|
| UFH |
Heparin |
30-90 min (dose dependent) |
Partial |
*Turn off infusion *Protamine 50 mg IV
|
