Overview
Recombinant modified factor Xa decoy that reverses direct and indirect Xa inhibitors (apixaban, rivaroxaban). Used for life-threatening bleeding. Expensive with limited availability.
Dosing
Low dose (apixaban ≤5mg or rivaroxaban ≤10mg): 400mg bolus, then 4mg/min x120min High dose: 800mg bolus, then 8mg/min x120min Max dose: 800mg bolus + 960mg infusion
Pharmacokinetics
Onset: Immediate Peak: End of bolus Duration: 1-2hr after infusion Metabolism: Unknown Half-life: 5-7hr
Pharmacodynamics
Mechanism: Xa inhibitor decoy → binds and sequesters anti-Xa drugs Effects: - Reverses anticoagulation - Thrombosis risk after reversal - No intrinsic procoagulant activity - Short duration
Clinical Considerations
Clinical Pearls: 1. Only for life-threatening bleeding 2. Monitor for rebleeding after effect wears off 3. Thrombosis risk - restart anticoagulation when safe 4. Very high cost 5. Limited availability 6. Not for heparin/warfarin 7. Give with blood products as needed 8. Consider PCC if unavailable