Elective Reversal (reversal needed within days)

• Before procedure
  • CrCl ≥50 mL/min
    • Low bleeding risk – hold ≥24 hours
    • High bleeding risk – hold 2-3 days
  • CrCl ≥30-50 mL/min
    • Low bleeding risk – hold 2 days before
    • High bleeding risk – hold 2-3 days
  • CrCl <30 mL/min
    • Low bleeding risk – hold 2-4 days
    • High bleeding risk – hold ≥5 days**
    •  

Urgent Reversal (not bleeding, reversal needed within hours)

• Hold further doses*
  1. 4-factor PCC (Kcentra)
  2. aPCC*
  3. 3-factor PCC + FFP

Urgent Reversal (bleeding, reversal needed immediately)

• HASHTI
• Idarucizumab***
• If Idarucizumab not available, consider:
  1. Hemodialysis in renal failure
  2. 4-factor PCC (Kcentra)
  3. aPCC
  4. 3-factor PCC + FFP
  5. If above ineffective or unavailable, may consider rVIIa

*The use of aPCC (FEIBA⁷⁰) may be associated with a higher risk of thrombosis compared with nonactivated PCCs¹¹⁰

*** Idarucizumab (Praxbind) dosing:  5 g I.V. (administered as 2 separate 2.5 g doses no more than 15 minutes apart). If coagulation parameters (eg, aPTT) re-elevate and clinically relevant bleeding occurs or if a second emergency surgery/urgent procedure is required and patient has elevated coagulation parameters, consider administration of an additional 5 g.