Factor Xa Inhibitor Reversal

Apixaban (Eliquis) and Rivaroxaban (Xarelto)

  • Andexanet alfa (Andexxa)


    • Last Xa Inhibitor dose > 8 hours ago

      • 400 mg IV andexanet alfa bolus at 30 mg/min, followed within 2 minutes by IV infusion of 4 mg/min for up to 120 minutes


    • Last Xa Inhibitor dose within past 8 hours

      • Low dose (5 mg or less of apixaban, 10 mg or less of rivaroxaban)

        • 400 mg IV andexanet alfa bolus at 30 mg/min, followed within 2 minutes by IV infusion of 4 mg/min for up to 120 minutes

      • High dose (>5 mg apixaban, >10 mg rivaroxaban) or unknown dose

        • 800 mg IV andexanet alfa bolus at 30 mg/min, followed within 2 minutes by IV infusion of 8 mg/min for up to 120 minutes

Fondaparinux

  • Consider hemodialysis

  • Consider Factor VIIa or Feiba NF (activated PCC) administration for life-threatening bleed