Anticoagulants are fantastic for preventing blood clots but can also be dangerous and cause bleeding. Here are some ways to reverse the bleeding effect of some of the most commonly used anticoagulants.
| Anticoagulant | Reversal agent |
| Heparin | Protamine sulfate • Max infusion rate is 5mg/min to prevent hypotension and bradycardia |
| Warfarin | Kcentra or Fresh frozen plasma PLUS Vitamin K IV Kcentra (4F-PCC) • If INR 2- <4: 25 units/kg (max 2500 units) • If INR 4-6: 35 units/kg (max 3500 units) • If INR >6: 50 units/kg (max 5000 units) Fresh frozen plasma (if Kcentra is unavailable) • 10-20 ml/kg Vitamin K • 5-10 mg IVPB (20-60 mins) • Repeat INR 30-60 minutes after administration |
| Fondaparinux | Kcentra • 50 units/kg (max 5000 units) single dose only |
| Dabigatran | Idarucizumab (Praxbind) • 50 g total dose ( divided doses of 2.5 g 15 minutes apart) Activated charcoal • If ingested <2 hours (100 g PO) FEIBA • 50 units/kg (max 5000 units) Tranexamic acid • 25mg/kg IV Desmopressin • 0.3 mcg/kg SQ or IV limit to 2 IV doses |
| Apixaban | Activated charcoal • If ingested <6hours (100g PO) Kcentra • 50 units/kg IV (single dose) Andexant alfa (if <5 mg/day) • 400 mg IV bolus at 30 mg/min followed by infusion at 4 mcg/min for 120 minutes Desmopressin • 0.3 mcg/kg SQ or IV limit to 2 IV doses Tranexamic acid • 25mg/kg IV |
| Rivaroxaban | Activated charcoal • If ingested <8 hours ago (100 g PO) Kcentra • 50 units/kg (single dose; max 5000 units) Andexant alfa • 800 mg IV bolus at 30 mg/min followed by infusion at 8 mcg/min for 120 minutes Desmopressin • 0.3 mcg/kg SQ or IV limit to 2 IV doses Tranexamic acid • 25mg/kg IV |
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