Riva-roxaban and apixaban are the most frequently prescribed DOACs in this country. Five DOACs are commercially available in the United States. Rationale for the Use of Rivaroxaban or Apixabanĭirect oral anticoagulants (DOACs) have been approved by the US Food and Drug Administration (FDA) for the management of a variety of conditions associated with increased risk for thromboembolic events. MedStar Georgetown University Hospital and Georgetown University Medical School Professor of Medicine and Pathology and Director of Division of Coagulationĭirector of Therapeutic and Cellular Apheresisĭirector of the Adult Comprehensive Hemophilia and Thrombophilia Treatment Center Off-label treatments used in this setting include prothrombin complex concentrates.īleeding After Treatment With Rivaroxaban or Apixaban The US Food and Drug Administration (FDA) recently granted accelerated approval to andexanet alfa, a recombinant protein analogue of factor Xa, for patients treated with rivaroxaban or apixaban who require reversal of anticoagulation owing to life-threatening or uncontrolled bleeding. The administration of a specific agent to reverse factor Xa inhibition may be clinically indicated in certain settings, such as when rivaroxaban and apixaban were given less than 12 hours earlier (assuming normal renal function), when the timing of the previous dose is unknown, or in the event of a catastrophic bleed. In some cases, it may be sufficient to provide supportive care while the agent is metabolized. Rivaroxaban and apixaban have relatively short half-lives. If a patient receiving treatment with a factor Xa inhibitor presents with a major bleeding event, the physician must determine whether reversal of anticoagulation is needed. Two of the most widely used direct oral anticoagulants (DOACs), rivaroxaban and apixaban, are factor Xa inhibitors. Abstract: Anticoagulants are used in several settings to reduce the risk of thromboembolic events, but they can be associated with severe complications, such as potentially fatal bleeding.
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