Bleeding with anticoagulation

The purpose of this page will be to focus on toxicity of anticoagulation, i.e., bleeding. It will be further organized over time.

Apixaban (Eliquis) reversal

Factor Xa, recombinant, inactivated-zhzo (Andexxa)

• Factor Xa, recombinant, inactivated-zhzo (Andexxa) as follows:
  • Apixaban dose up to 5 mg: 400 mg IV bolus at a target rate of 30 mg/min then 480 mg IV infusion at a rate of 4 mg/min for 2 hours
  • Apixaban dose greater than 5mg or unknown but at least 8 hours since last administration: 400 mg IV bolus at a target rate of 30 mg/min then 480 mg IV infusion at a rate of 4 mg/min for 2 hours
  • Apixaban dose greater than 5mg or unknown and less than 8 hours since last administration: 800mg IV bolus at a target rate of 30 mg/min then 960 mg IV infusion at a rate of 8 mg/min for 2 hours

References

1. ANNEXA-A/ANNEXA-R: Siegal DM, Curnutte JT, Connolly SJ, Lu G, Conley PB, Wiens BL, Mathur VS, Castillo J, Bronson MD, Leeds JM, Mar FA, Gold A, Crowther MA. Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med. 2015 Dec 17;373(25):2413-24. Epub 2015 Nov 11. link to original article PubMed
2. ANNEXA-4: Connolly SJ, Milling TJ Jr, Eikelboom JW, Gibson CM, Curnutte JT, Gold A, Bronson MD, Lu G, Conley PB, Verhamme P, Schmidt J, Middeldorp S, Cohen AT, Beyer-Westendorf J, Albaladejo P, Lopez-Sendon J, Goodman S, Leeds J, Wiens BL, Siegal DM, Zotova E, Meeks B, Nakamya J, Lim WT, Crowther M; ANNEXA-4 Investigators. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med. 2016 Sep 22;375(12):1131-41. Epub 2016 Aug 30. link to original article link to PMC article PubMed

Dabigatran (Pradaxa) reversal

Idarucizumab (Praxbind)

• To be completed

Dalteparin (Fragmin) reversal

Protamine sulfate (USP)

• To be completed

Enoxaparin (Lovenox) reversal

Protamine sulfate (USP)

• To be completed

Heparin reversal

Protamine sulfate (USP)

• To be completed

Rivaroxaban (Xarelto) reversal

Factor Xa, recombinant, inactivated-zhzo (Andexxa)

• Factor Xa, recombinant, inactivated-zhzo (Andexxa) as follows:
  • Rivaroxaban dose up to 10mg: 400 mg IV bolus at a target rate of 30 mg/min then 480 mg IV infusion at a rate of 4 mg/min for 2 hours
  • Rivaroxaban dose greater than 10mg or unknown but at least 8 hours since last administration: 400 mg IV bolus at a target rate of 30 mg/min then 480 mg IV infusion at a rate of 4 mg/min for 2 hours
  • Rivaroxaban dose greater than 10mg or unknown and less than 8 hours since last administration: 800mg IV bolus at a target rate of 30 mg/min then 960 mg IV infusion at a rate of 8 mg/min for 2 hours

References

1. ANNEXA-A/ANNEXA-R: Siegal DM, Curnutte JT, Connolly SJ, Lu G, Conley PB, Wiens BL, Mathur VS, Castillo J, Bronson MD, Leeds JM, Mar FA, Gold A, Crowther MA. Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med. 2015 Dec 17;373(25):2413-24. Epub 2015 Nov 11. link to original article PubMed
2. ANNEXA-4: Connolly SJ, Milling TJ Jr, Eikelboom JW, Gibson CM, Curnutte JT, Gold A, Bronson MD, Lu G, Conley PB, Verhamme P, Schmidt J, Middeldorp S, Cohen AT, Beyer-Westendorf J, Albaladejo P, Lopez-Sendon J, Goodman S, Leeds J, Wiens BL, Siegal DM, Zotova E, Meeks B, Nakamya J, Lim WT, Crowther M; ANNEXA-4 Investigators. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med. 2016 Sep 22;375(12):1131-41. Epub 2016 Aug 30. link to original article link to PMC article PubMed

Bleeding risk calculators

• Bleeding risk on anticoagulation: HAS-BLED; HEMORR2HAGES