Factor Xa Inhibitors

(Apixaban, Rivaroxaban, Edoxaban, Betrixaban; t½ ~6–14 hrs)

🚨 Major / life-threatening bleeding (incl. ICH)

• PCC (Kcentra or Balfaxar):

  • 2000 units IV (fixed dose)

• Redosing:

  • May give additional dose if bleeding not controlled

Dabigatran (Direct Thrombin Inhibitor)

(t½ ~12–24 hrs, renal dependent)

🚨 Major bleeding / emergent surgery

• Idarucizumab (Praxbind) 5 g IV (bolus or infusion

⚠️ Additional considerations:

• Repeat dose:

  • Not routinely recommended

  • May consider if:

    • Recurrent bleeding + elevated aPTT after 12–24 hrs

• Activated charcoal:

  • If ingestion <2 hrs (may help up to 8 hrs)

Direct Thrombin Inhibitors (DTIs) (Argatroban, Bivalirudin)

• Action:
  👉 STOP infusion immediately

• Rationale:

  • Very short half-life (~25–50 min) → effect wears off quickly

short version

• DTI (argatroban, bivalirudin):
  → Stop infusion (short half-life)

• Dabigatran:
  → Idarucizumab 5 g IV
  → Consider repeat if rebleed + ↑ aPTT
  → Activated charcoal if ingestion <2 hrs

• Factor Xa inhibitors (apixaban, rivaroxaban, edoxaban):
  → PCC 2000 units IV
  → Repeat if bleeding persists
  → Use PCC for emergent surgery