Usual Adult Dose for Reversal of Anticoagulation

Reversal of Apixaban Anticoagulation:
Last apixaban dose was 5 mg or less: 400 mg IV bolus at a target rate of 30 mg/min, followed within 2 minutes later by 4 mg/min IV infusion for up to 120 minutes

Last apixaban dose was greater than 5 mg (or unknown) and was administered less than 8 hours (or unknown) ago: 800 mg IV bolus at a target rate of 30 mg/min, followed within 2 minutes later by 8 mg/min IV infusion for up to 120 minutes

Last apixaban dose was greater than 5 mg (or unknown) and was administered at least 8 hours ago: 400 mg IV bolus at a target rate of 30 mg/min, followed within 2 minutes later by 4 mg/min IV infusion for up to 120 minutes

Comments: Resume anticoagulant therapy as soon as medically appropriate following treatment with this drug.

Use: Reversal of anticoagulation in patients who have been treated with apixaban and are experiencing life-threatening or uncontrolled bleeding.

Reversal of Rivaroxaban Anticoagulation:
Last rivaroxaban dose was 10 mg or less: 400 mg IV bolus at a target rate of 30 mg/min, followed within 2 minutes later by 4 mg/min IV infusion for up to 120 minutes

Last rivaroxaban dose was greater than 10 mg (or unknown) and was administered less than 8 hours (or unknown) ago: 800 mg IV bolus at a target rate of 30 mg/min, followed within 2 minutes later by 8 mg/min IV infusion for up to 120 minutes

Last rivaroxaban dose was greater than 5 mg (or unknown) and was administered at least 8 hours ago: 400 mg IV bolus at a target rate of 30 mg/min, followed within 2 minutes later by 4 mg/min IV infusion for up to 120 minutes

Comments: Resume anticoagulant therapy as soon as medically appropriate following treatment with this drug.

Use: Reversal of anticoagulation in patients who have been treated with rivaroxaban and are experiencing life-threatening or uncontrolled bleeding.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

US BOXED WARNING:

• THROMBOEMBOLIC RISKS, ISCHEMIC RISKS, CARDIAC ARREST, AND SUDDEN DEATHS: Treatment with this drug has been associated with serious and life-threatening adverse events, including: arterial and venous thromboembolic events; ischemic events, including myocardial infarction and ischemic stroke; cardiac arrest; sudden deaths. Monitor for thromboembolic events and initiate anticoagulation when medically appropriate. Monitor for symptoms and signs that precede cardiac arrest and provide treatment as needed.

Dialysis

Data not available

Other Comments

Administration advice: Administer IV using a 0.2 or 0.22 micron in-line polyethersulfone or equivalent low protein-binding filter.

Storage requirements:

• Unopened vials should be refrigerated at 2C to 8C (36F to 46F). Do not freeze.
• When reconstituted in vials, may be stored at room temperature for up to 8 hours, or at 2C to 8C for up to 24 hours.
• When reconstituted in IV bags, may be stored at room temperature for up to 8 hours, or at 2C to 8C for up to 16 hours.

• Cardiovascular: Signs and symptoms of arterial and venous thromboembolic events, ischemic events, and cardiac arrest.