IV/O2/Monitor, ABCs
Standard resuscitation with IVF; PRBCs if needed
If ICH, treat for increased ICP
Currently published manuscripts and protocols is that either PCC or aPCC is recommended as a reversal agent for DTIs and FXa inhibitors, with no clear data as to which is superior.
Consider Tranexamic acid
If ingested within 2 hours, administer activated charcoal
4-factor PCC (Kcentra™)^
25units/kg—max 2500 units for treatment of documented intracranial hemorrhage
50 units/kg—max 5000 units for all other life-threatening bleeds
25units/kg—max 2500 units for treatment of documented intracranial hemorrhage
50 units/kg—max 5000 units for all other life-threatening bleeds
^Off-label
FDA approved in May 2018, limited availability June 2018
Cost is $20,000 to $55,000 per dose
Trial that led to FDA approval does not have the most sound evidence behind it :
Prospective single center single group study of 352 patients receiving a Factor Xa Inhibitor (apixaban,<unk> , edoxaban, enoxaparin) with life threatening bleed (those with expected survival <1 month were excluded).
Anti-Factor Xa activity was decreased in all groups. 82% were judged to have excellent hemostatic control. 14% mortality rate at 30 days.
No comparison group available. It is unlikely that following anti-Factor Xa activity as a lab value is clinically important. High mortality rate even after excluding sick patients.
Prospective single center single group study of 352 patients receiving a Factor Xa Inhibitor (apixaban,<unk> , edoxaban, enoxaparin) with life threatening bleed (those with expected survival <1 month were excluded).
Anti-Factor Xa activity was decreased in all groups. 82% were judged to have excellent hemostatic control. 14% mortality rate at 30 days.
No comparison group available. It is unlikely that following anti-Factor Xa activity as a lab value is clinically important. High mortality rate even after excluding sick patients.

400 mg IV bolus at rate of ~30 mg/minute, followed 2 minutes later by 4 mg/minute for up to 120 minutes
800 mg IV bolus at rate of ~30 mg/minute, followed 2 minutes later by 8 mg/minute for up to 120 minutes
Rivaroxaban reversal
Bleeding secondary to other coagulopathy
Dabigatran reversal
Spontaneous bleeding
Warfarin reversal
Unfractionated heparin reversal
Anti-platelet agent reversal
Enoxaparin