Table 8.

Anticoagulant and the reversal agents

Anticoagulant	Evaluation test	Half-life (hours)	Reversible	Reversal agent(s) Consult hematologist	Reversal agent Half-life
Antithrombin III activator (FII and FX inhibitor)
IV Heparin	aPTT	1.5	Yes	Protamine (1mg/100 units heparin)	7–8 minutes
Vitamin K inhibitor
Warfarin	PT/INR	40	Yes	Vitamin K 10 mg Prothrombin complex concentrate 20–50 units/kg rFVIIa 90 µg/kg FFP	2 hours 4–12 hours 2.3 hours 4–12 hours
Factor X inhibitor
LMWH Enoxaparin	Anti-FXa	7	Partial	Protamine If received <2 hours (60–80%) 1mg protamine/1mg enoxaparin If received >8 hours before: 0.5 mg protamine/1 mg enoxaparin If received >12 hours before: Nil rFVIIa (70–90 mg/kg) in severe bleeds	7–8 minutes 2.3 hours
LMWH Dalteparin	Anti-FXa	3-5	Partial	Protamine If received <2 hours: (60%) 1 mg protamine/1 mg dalteparin rFVIIa (70–90 mg/kg) in severe bleeds	7–8 minutes 2.3 hours
Direct FXa inhibitors
Apixaban	Anti-FXa	8–15	No	Andexxa (rXa, inactivated-zhzo) <8 hours:400 mg–800 mg at 30 mg/minute; >8 hours 400 mg Prothrombin complex concentrate 25–50 units/kg	1 hour 4–60 hours
Rivaroxaban	Anti-FXa	7–11	No	Andexxa (rXa, inactivated-zhzo) <8 hours:400 mg–800 mg at 30 mg/minute; >8 hours 400 mg Prothrombin complex concentrate 25–50 units/kg rFVIIa 90 mg/kg	1 hour 4–60 hours 2.3 hours
Direct FIIa inhibitors
Dabigatran	Limited value except TT, TEG, anti-FIIa	12–17	No	Idarucizumab (if TT is prolonged) 5 mg bolus or infusion over 5–10 minutes Prothrombin complex concentrate 50 units/kg	Biphasic: 45 minutes, 4–8 hours 4–12 hours
Argatroban	Limited value except TEG anti-FIIa	0.75	No	rFVIIa 90 µg/kg	2.3 hours
Tissue plasminogen activator
Alteplase	D-dimer	0.5–0.75	Yes	Tranexamic acid 10 mg/kg	2 hours