Binds to and sequesters rivaroxaban or apixaban, thereby negating their anticoagulant effects. Also inhibits the activity of tissue factor pathway inhibitor, increasing tissue factor-initiated thrombin generation.
Therapeutic Effect(s):
Reversal of the anticoagulant effect of rivaroxaban or apixaban.
Low Dose (should be administered if last dose of rivaroxaban ≤10 mg, last dose of apixaban ≤5 mg, or time since patient's last dose (any dose) of rivaroxaban or apixaban ≥8 hr)
IV (Adults): 400 mg IV bolus, followed by 4 mg/min continuous infusion administered for up to 120 min (2 hr).
High Dose (should be administered if last dose of rivaroxaban >10 mg, apixaban >5 mg, or unknown dose AND dose given < 8 hr or at unknown time
IV (Adults): 800 mg IV bolus, followed by 8 mg/min continuous infusion administered for up to 120 min (2 hr).
Reversal of rivaroxaban or apixaban exposes patient to thrombotic risk of their underlying disease; may cause thromboembolism. Monitor for signs and symptoms of thromboembolism (pain, swelling, tenderness in extremities; headache; chest pain; blurred vision) and signs and symptoms that precede cardiac arrest (chest pain, dyspnea, nausea, vomiting, dizziness) and provide treatment as needed. Resume anticoagulant therapy as soon as medically appropriate.
IV Push: Reconstitute each vial with sterile water for injection slowly, directing solution to inside wall of vial to minimize foaming for a concentration of 10 mg/mL. Swirl gently until powder is completely dissolved; do not shake. Dissolution usually takes 3–5 min; discard vials with incomplete dissolution. Solution is clear; do not administer solutions that are discolored or contain particulate matter. Solution is stable for 8 hr at room temperature or 24 hr if refrigerated. Withdraw solution from each vial using a ≥60 mL syringe and a 20-gauge needle until required dosing volume in achieved. Transfer solution from syringe into an empty polyolefin or polyvinyl chloride IV bag with a volume of ≤250 mL. Discard syringe, needle, and unused portion of vials.
Rate: Infuse through a 0.2 or 0.22 micron in-line polyethersulfone or equivalent low protein-binding filter at a rate of 30 mg/min.
Continuous Infusion: Follow the same procedure as IV bolus preparation.
Rate: Within 2 min following bolus dose, administer continuous IV infusion for up to 120 minutes.