Ver el código de «Rivaroxaban reversal»

==Background==
*Millions are prescribed [[rivaroxaban]] (Xarelto) for atrial fibrillation, cardiac stents, stroke prevention, DVT/PE and ACS prophylaxis<ref>Connolly SJ, et al. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2019;380(14):1326-1335. PMID 30730782</ref>
*Benefits: supposedly easier to dose, less monitoring than older anticoagulants
*Downside: uncertainty regarding best mechanism of reversal in case of catastrophic intracranial or GI bleed
*Multiple studies done since introduction of direct thrombin inhibitor (DTI) [[dabigatran]] and Factor Xa inhibitors [[rivaroxaban]] and [[apixaban]] to determine testing for supratherapeutic levels and best means of reversal, however no good trials that assessing human subjects who are potentially supratherapeutic and symptomatic

==Clinical Features==
*Patient taking rivaroxaban with a life-threatening bleeding event (GI, ICH, etc.)

==Differential Diagnosis==
*Bleeding secondary to other coagulopathy
*Spontaneous bleeding

==Evaluation==
*CBC
*aPTT/PT: Factor Xa inhibitors affect PT, however unlike with warfarin, degree of PT elevation not directly correlated to level of anticoagulation 
*non contrast head CT showing ICH
*Antifactor Xa assays- measure drug levels but not degree of anticoagulation, need to be calibrated for rivaroxaban not LMWH, and often not available in a timely fashion
*Evaluation of clinical manifestation of bleeding (e.g. head CT, endoscopy)

==Management==
*IV/O2/Monitor, ABCs
*Standard resuscitation with IVF; PRBCs if needed
*If [[ICH]], treat for [[increased ICP]]
*Currently published manuscripts and protocols is that either [[PCC]] or aPCC is recommended as a reversal agent for DTIs and FXa inhibitors, with no clear data as to which is superior.
*Consider Tranexamic acid

{{Factor Xa Inhibitor Reversal}}

==Disposition==
*admission to a monitored setting

==See Also==
*[[Anticoagulant reversal for life-threatening bleeds]]

==External Links==

==References==
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#Awad, N., & Cocchio, C. (2013). Activated Prothrombin Complex Concentrates for the Reversal of Anticoagulant-Associated Coagulopathy. Pharmacy And Therapeutics, 38(11), 696.
#Babilonia, K., & Trujillo, T. (2014). The role of prothrombin complex concentrates in reversal of target specific anticoagulants. Thrombosis Journal, 12(1), 8. doi:10.1186/1477-9560-12-8
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[[Category:Heme/Onc]]