Table 2.
Anticoagulation Reversal Agents Summary
| Reversal Agent |
Rationale | Time to Effect16 |
Duration/Half life16 |
Warfarin Reversal |
Dabigatran Reversal |
Rivaroxaban Reversal |
|---|---|---|---|---|---|---|
| Vitamin K | Increases synthesis of vitamin K dependent proteins | 4–6 hours | Length of effect until coagulation is restored.a | Consider in patients with high risk of bleed (INR >4.5) and recommended use in patients with need of urgent reversal (INR >10, peri-perative, bleeding) | Not recommended | Not recommended |
| FFP | Contains all coagulation proteins including fibrinolytic and complement factors | 10 minutes | 1.5–2 days | If urgent reversal needed (emergency surgery, bleeding) | Not recommended | Not recommended |
| PCC | Replaces Deficient Clotting factors II, VII, IX, Xb | 10 minutes | 6–8 hours | If urgent reversal needed (emergency surgery, bleeding) | If urgent Reversal needed and supportive measures failc | If urgent reversal needed and supportive measures failc |
| rVIIa | Replenishes factor VIIa, thereby increasing coagulation | 10 minutes | <60 minutes | If urgent reversal needed (emergency surgery, bleeding) | If urgent reversal needed and supportive measures faild | If urgent reversal needed and supportive measures faild |
INR = international normalized ratio; FFP = fresh frozen plasma; PCCs = prothrombin complex concentrates; rFVIIa = recombinant factor VIIa.
a
Vitamin K can take up to 36 hours to reach maximum therapeutic effect.16
b
3 Factor PCCs have low amounts of factor VII.
c
Human data indicates possible use for both non-activated and activated PCCs.
d
No human clinical evidence available.