Elective Reversal (reversal needed within days)

• Low bleeding risk procedure
  • Hold ≥24 hrs
• High bleeding risk procedure
  • Hold ≥48 hrs

Urgent Reversal (not bleeding, reversal needed within hours)

• Hold further doses
• Consider:

1. Andexanet alfa (Andexxa)**
2. Activated charcoal if ingestion <6 hrs
3. 4-factor PCC (Kcentra 25 units/kg, max 2500 units)/ aPCC*
4. 3-factor PCC + FFP

Urgent Reversal (bleeding, reversal needed immediately)

• HASHTI

1. Andexanet alfa (Andexxa)**
2. Activated charcoal if ingestion <6 hrs
3. 4-factor PCC (Kcentra 50 units/kg, max 5000 units)/ aPCC*
4. 3-factor PCC + FFP
5. If above unavailable, may consider rVIIan

*The use of aPCC (FEIBA⁷⁰) may be associated with a higher risk of thrombosis compared with nonactivated PCCs¹¹⁰

**Andexanet Alfa (Andexxa) dosing:

Apixaban:

• ≤ 5 mg given in < 8 hrs or higher dose given ≥ 8 hrs:  400 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 4 mg/minute IV infusion for up to 120 minutes
• > 5 mg given in < 8 hrs: 800 mg IV bolus administered at a rate of ~30 mg/minute, followed 2 minutes later by 8 mg/minute IV infusion for up to 120 minutes