Anticoagulant Reversal Table

Drug Class		Drug names	Monitoring Parameters	Half-life	Reversal Agents
Oral Vitamin K Antagonists		Warfarin	PT/INR	36-48 hours	Life-threatening: 4-Factor PCC+ IV Vitamin K Non-urgent: IV Vitamin K Alternative*: FFP
Heparins	Unfractionated Heparin	Heparin	Anti-Factor Xa activity level, aPTT	60-90 minutes	Protamine
	Low Molecular Weight Heparin	Enoxaparin, Dalteparin	Anti-Factor Xa activity level	3-6 hours*	Protamine
	Synthetic Factor Xa Inhibitors	Fondaparinux	Anti-Factor Xa activity level	17-21 hours*	FEIBA or Factor VIIa
Direct Oral Anticoagulants (DOACs)	Direct Thrombin Inhibitors	Dabigatran	aPTT	12-14 hours*	Idaracizumab
	Direct Xa Inhibitors	Rivaroxaban, Apixaban, Edoxaban, Betrixaban	Anti-Factor Xa activity level (Rivaroxaban, Apixaban)	Rivaroxaban: 5-9 hours^₸ Apixaban: 12 hours Edoxaban 10-14 hours	Intracranial Hemorrhage: Andexanet Alfa Other life-threatening bleed*: 4-Factor PCC

* May be prolonged in acute kidney injury or renal failure

* K-Centra (4 factor PCC) Use restricted to neurosurgery, stroke team, emergency medicine, trauma, and hematology

** Andexanet Restricted to emergency department, neurosurgery, stroke team, neurocritical care, or hematology approval

₸ May be prolonged in the setting of hepatic injury or failure

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Anticoagulant Reversal Table, Michigan Medicine, Dept of Surgery, “CC BY-NC 4.0”