It competitively inhibits the factor Xa active site, blocking obtainable receptors for anticoagulation. Reversal of edoxaban and the indirect inhibitor enoxaparin is also feasible with andexanet, 1 but further data on safety and efficacy is needed.Īndexanet is effective in decreasing the activity of rivaroxaban and apixaban within 2 to 5 minutes of administration.

2 The recombinant coagulation factor Xa protein sequesters their anticoagulation effect. 1Īndexanet alfa (Andexxa, Portola Pharmaceuticals) was approved by the FDA in May for emergency reversal of two direct factor Xa inhibitors, rivaroxaban and apixaban.

DOAC bleeding risk occurs at an annual rate of 2.1% to 3.5% and increases during surgical interventions. They allow for less frequent INR sticks, consistent dosing regimens, and food choice flexibility. Rate: Within 2 min following bolus dose, administer continuous IV infusion for up to 120 minutes.Direct oral anticoagulants (DOACs) have revolutionized the drug market.Continuous Infusion: Follow the same procedure as IV bolus preparation.Rate: Infuse through a 0.2 or 0.22 micron in-line polyethersulfone or equivalent low protein-binding filter at a rate of 30 mg/min.Discard syringe, needle, and unused portion of vials. Transfer solution from syringe into an empty polyolefin or polyvinyl chloride IV bag with a volume of ≤250 mL. Withdraw solution from each vial using a ≥60 mL syringe and a 20-gauge needle until required dosing volume in achieved. Solution is stable for 8 hr at room temperature or 24 hr if refrigerated. Solution is clear do not administer solutions that are discolored or contain particulate matter. Dissolution usually takes 3–5 min discard vials with incomplete dissolution. Swirl gently until powder is completely dissolved do not shake. IV Push: Reconstitute each vial with sterile water for injection slowly, directing solution to inside wall of vial to minimize foaming for a concentration of 10 mg/mL.