Template:Factor Xa Inhibitor Reversal
|Anticoagulant||Half-life||Removed by HD||Strategies to reverse or minimize anticoagulant effects|
|Apixaban (Eliquis®)||8-15 hrs (longer in renal impairment)||No||
|Edoxaban (Savaysa®)||10-14 hrs (longer in renal impairment)||~ 25%||As above|
|Rivaroxaban (Xarelto®)||9-13 hrs (longer in renal impairment)||No||As above|
|Fondaparinux (Arixtra®)||17-21 hrs (significantly longer in renal impairment)||No||4-factor PCC (Kcentra™)^ 50 units/kg—max 5000 units|
FDA approved in May 2018, limited availability June 2018
- Cost is $20,000 to $55,000 per dose
- Trial that led to FDA approval does not have the most sound evidence behind it :
- Prospective single center single group study of 352 patients receiving a Factor Xa Inhibitor (apixaban, rivaroxaban, edoxaban, enoxaparin) with life threatening bleed (those with expected survival <1 month were excluded).
- Anti-Factor Xa activity was decreased in all groups. 82% were judged to have excellent hemostatic control. 14% mortality rate at 30 days.
- No comparison group available. It is unlikely that following anti-Factor Xa activity as a lab value is clinically important. High mortality rate even after excluding sick patients.
400 mg IV bolus at rate of ~30 mg/minute, followed 2 minutes later by 4 mg/minute for up to 120 minutes
800 mg IV bolus at rate of ~30 mg/minute, followed 2 minutes later by 8 mg/minute for up to 120 minutes
- Eliquis prescribing information. Princeton, NJ: Bristol Myers Squibb; December 2012.
- Savaysa prescribing information. Parsippany, NJ: Daiichi Sankyo, Inc.; November 2015.
- Xarelto prescribing information. Titusville, NJ: Janssen Pharmaceuticals, Inc.; December 2014.
- Connolly SJ, Crowther M, Eikelboom JW, et al. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2019