Type of anticoagulants | Specific agents | Reversal agents | Strategy for reversal | Cautions | Laboratory evaluation |
---|---|---|---|---|---|
Vitamin K antagonists | Warfarin | Vitamin K | 10Â mg IV | Anaphylaxis | INR |
FFP | 4 U or 12Â ml/kg IV | Fluid overload | |||
PCCs | If INR 1.7–4, give 25 U/kg; if INR 4–6, give 35 U/kg; if INR > 6, give 50 U/kg. (targeting INR level < 1.3 within 4 h) | Thrombotic events | |||
Direct thrombin inhibitors | Dabigatran | Idarucizumab | Preferred drug Single 5Â g/100Â ml dose, repeat if needed | Headaches | APTT, TT |
Medicinal activated charcoal | 50 g if DOACs are ingested < 2 h | - | |||
Direct factor Xa inhibitors | Apixaban; Betrixaban; Edoxaban; Rivaroxaban | Andexanet alfa | Preferred drug 800 mg bolus over 30 min, then 960 mg over 2 h if the last intake ≤ 7 h; 400 mg bolus over 15 min, then 480 mg over 2 h if the last intake > 7 h | Thrombotic events | Anti-Xa activity |
4-factor PCC | 50Â IU/kg IV (off-label) | Thrombotic events | |||
Medicinal activated charcoal | 50 g if DOACs are ingested < 2 h | - | |||
Heparinoids | UFH | Protamine sulfate | 1Â mg IV for every 100 U of heparin given in the previous 3Â h (up to 50Â mg in a single dose) | Bradycardia, hypotension | APTT, Anti-Xa activity |