According to the Hemostasis and Thrombosis Research Society, the use of four-factor PCCs seems to be a reasonable approach to reversing the effects of direct Xa inhibitors. 160 Although the effectiveness is suggested in animal bleeding models, there have been no studies evaluating the effect of PCCs on clinical bleeding in humans receiving factor Xa inhibitors. Four-factor PCCs also seem effective at reversing abnormal coagulation parameters in healthy humans taking these medications. ![]() 157–159 As a result, FEIBA is an acceptable agent to reverse the effects of direct Xa inhibitors. In contrast, FEIBA was effective in reversing abnormal coagulation studies in rivaroxaban-treated healthy volunteers and seemed to be effective at reversing bleeding in two animal models. At the present time, rFVIIa is not recommended as a reversal agent for direct factor Xa inhibitors. 156 rFVIIa failed, however, to reverse active bleeding in a rivaroxaban animal model. In an ex vivo study of healthy volunteers, rFVIIa reversed abnormal coagulation studies in patients who were given rivaroxaban. ![]() ![]() ![]() A variety of strategies using rFVIIa, PCC, and FEIBA have been tried in the treatment of these patients. Roberts MD, FACEP, FAAEM, FACMT, in Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 2019 Direct Factor Xa inhibitors (Rivaroxaban, Apixaban, Edoxaban)ĭirect factor Xa inhibitors also present a challenge to reversal in the setting of acute hemorrhage.
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