Apixaban Reversal Information

Andexanet was the only reversal agent with FDA approval for apixaban reversal. However, following the U.S. withdrawal of andexanet alfa in December 2025 due to an unfavorable risk-benefit profile (driven primarily by excess TE), no specific reversal agent for factor Xa inhibitors remains available in the US. In the absence of a specific factor Xa inhibitor reversal agent approved for pediatric use, clinicians must rely on the off-label use of prothrombin complex concentrates for bleeding or urgent procedures, emphasizing the importance of careful perioperative planning
Kcentra (prothrombin complex concentrate) 25-50 units/kg for severe bleeding or NovoSeven (rFVIIa) 90 mcg/kg. FEIBA (activated PCC) 50 units/kg would be a last resort due to higher thrombosis risk. They are on formulary at PMCH but are not labeled by the manufacturer for reversal of apixaban.
In the setting of overdose, also consider administration of activated charcoal (50 g) if within 2 hours of dose.
Apixaban is NOT dialyzable because it is mostly protein bound.
Repeat monitoring tests for anticoagulant and platelets, PT, PTT, and fibrinogen after infusing a reversal agent and q 4-6 hours until severe bleeding risk has passed. Determine if and when anticoagulation should be reinitiated and what agent. Monitor patient for thrombosis and bleeding.

Abbreviation	Definition
AAA	Abdominal Aortic Aneurysm
ABCs	Airway, breathing and circulation
ABS	Acrylonitrile Butadiene Styrene
ACS	Acute Coronary Syndrome
ACT	Activated clotting tim
Anti-Xa	Anti factor Xa level; used for monitoring heparins
APLA	Antiphospholipid antibody syndrome
approx	Approximately
APTT	Activated partial thromboplastin time
ASA	Acetylsalicylic acid
AT3	Antithrombin 3
BID	Twice Daily
CABG	Coronary artery bypass grafting
CBC	Complete blood count
CDT	Catheter-directed Thrombolysis
CI	Continuous infusion
CMP	Comprehensive metabolic panel
COX	Cyclooxygenase
Cryo	Cryoprecipitate
DAT	Direct antiglobulin test
DDAVP	Desmopressin acetate
DIC	Disseminated intravascular coagulation
DVT	Deep venous thrombosis
EACA	Epsilon aminocaproic acid
F	Factor
FEIBA	Factor eight inhibitor bypassing activity
FFP	Fresh frozen plasma
FIX	Factor IX
Gm	Gram
HAV	Hepatitis A virus
Hb	Hemoglobin
HBV	Hepatitis B virus
HCV	Hepatitis C virus
HD	Hemodialysis
HIV	Human immunodeficiency virus
hrs	Hours
I.V.	Intravenous
ICU	Intensive care unit
INR	International normalized ratio
IPA	Inhibition of Platelet Aggregation
IU/kg	International units per kilogram of body weight
LFT	Liver function tests
LMWH	Low molecular weight heparin mcg
mcg	Microgram
mg	Milligram
MI	Myocardial infarction
min	Minutes
NOAC	Non Vitamin K Oral Anticoagulant
P.O.	Per os (oral)
PAI-1	Plasminogen activator inhibitor-1
PCC	Prothrombin Complex Concentration
PCI	Percutaneous Coronary Intervention
PE	Pulmonary embolism
PFA-100	Platelet function analyzer-100; in vitro bleeding time
PRN	As Needed
PT	Prothrombin time
Q	Every
QID	Four times daily
RES	Reticuloendothelial system
rt-PA	Recombinant tissue plasminogen activator
rVIIa	Recombinant factor VIIa (NovoSeven RT)
SC	Subcutaneous
STEMI	ST-Elevation Myocardial Infarction
TCT	Thrombin clotting time
TEG	Thromboelastogram
TPA	Tissue plasminogen activator
U/kg	Units/ kg
UFH	Unfractionated heparin
VKA	Vitamin K antagonists

Abbreviations