Elective Reversal (reversal needed within days)

• Low bleeding risk procedure
  • Hold ≥24 hours
• High bleeding risk procedure
  • Hold ≥48 hrs

Urgent Reversal (not bleeding, reversal needed within hours)

• Hold further doses
• Consider:
  1. Andexanet alfa (Andexxa)**
  2. Activated charcoal if ingestion <8 hrs
  3. 4-factor PCC (Kcentra 25 units/kg, max 2500 units)/aPCC*
  4. 3-factor PCC + FFP

Urgent Reversal (bleeding, reversal needed immediately)

• HASHTI:
  1. Andexanet alfa (Andexxa)**
  2. Activated charcoal if ingestion <8 hrs
  3. 4-factor PCC (Kcentra 50 units/kg, max 5000 units)/aPCC*
  4. 3-factor PCC + FFP
  5. If above unavailable, may consider rVIIa

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

** Andexanet alfa (Andexxa) dosing:

• Rivaroxaban:
  • ≤ 10 mg given in < 8 hrs or higher dose given ≥ 8 hrs:  400 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 4 mg/minute IV infusion for up to 120 minutes
  • > 10 mg given in < 8 hrs: 800 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 8 mg/minute IV infusion for up to 120 minutes