16
Treatment
Table 5. Anticoagulant and Antiplatelet Medications and
Appropriate Reversal Agents Based on Severity of
Bleeding
a
Medication
Reversal Agent
(for severe or
life-threatening
bleeding) Comments
VKA
• Warfarin (Coumadin
®
)
• Fresh frozen
plasma
• 4-Factor PCC
• Vitamin K
(should not be
used alone for
life-threatening
bleeding )
• 4-factor PCC has a shorter
time to correction of INR and a
smaller volume to infuse.
• IV or oral Vitamin K can be
used in non-severe bleeding.
• Treatment should be based on
bleeding severity in combination
with INR.
Heparin
• Unfractionated
• LMWH
(Lovenox
®
, Fragmin
®
)
Protamine sulfate
DOACs
• Dabigatran (Pradaxa
®
)
• Edoxaban
(Savaysa
®
, Lixiana
®
)
• Apixiban (Eliquis
®
)
• Rivaroxaban (Xarelto
®
)
• 4-Factor PCC
• Idarucixumab
(Praxbind
®
,
dabigatran only)
Antifibrinolytics and desmopressin
may be used to support hemostasis,
though they do not reverse the
anticoagulation effect.
Platelet Inhibitors
• Aspirin
• Clopidogrel (Plavix
®
)
• Prasugrel (Effient
®
)
• Ticagrelor (Brilinta
®
,
Brilique
®
, Possia
®
)
• Ticlodipine (Ticlid
®
)
Platelet transfusion Platelet transfusion may not be
effective depending on timing of
most recent dose of medication;
if active medication is present,
transfused platelets will be affected
in the same way as the patient's
platelets.
Antifibrinolytics and desmopressin
may be used to support hemostasis,
though they do not reverse the
platelet inhibitory effects.
a
It is important to discuss with the primary service managing the anticoagulation prior to fully
reversing a patient's anticoagulation. Note that this table provides some of the more common
medications in each class but is not an exhaustive list of these medications. VKA=vitamin K
antagonist (e.g., warfarin [Coumadin®]; PCC=prothrombin complex concentrates, contains
inactive factors II, VII, IX, and X; INR=international normalized ratio; LMWH=low molecular
weight heparin (e.g., enoxaparin [Lovenox®] or dalteparin [Fragmin®]); DOAC=direct oral
anticoagulant (e.g., rivaroxaban [Xarelto®], dabigatran [Pradaxa®], and others).
