Type of bleeding | Agent | Possible interventions |
Life-threatening or imminently fatal bleeding (eg, intracranial, retroperitoneal, compartment syndrome, massive gastrointestinal) | Dabigatran (Pradaxa) | - Idarucizumab
- Activated PCC* (eg, FEIBA)
- Antifibrinolytic agent (eg, tranexamic acid, epsilon-aminocaproic acid)
- Anticoagulant discontinuation
- Oral activated charcoal (if last dose within prior two hours)
- Hemodialysis
- RBC transfusions if needed for anemia
- Platelet transfusions if needed for thrombocytopenia or impaired platelet function (eg, due to aspirin)
- Surgical/endoscopic intervention if appropriate
|
Rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Lixiana) | - Andexanet alfa (AndexXa) or a 4-factor unactivated PCC (eg, Kcentra)
- Antifibrinolytic agent (eg, tranexamic acid, epsilon-aminocaproic acid)
- Anticoagulant discontinuation
- Oral activated charcoal (if last dose recent enough)
- RBC transfusions if needed for anemia
- Platelet transfusions if needed for thrombocytopenia or impaired platelet function (eg, due to aspirin)
- Surgical/endoscopic intervention if appropriate
|
Minor bleeding (eg, epistaxis, uncomplicated soft tissue bleeding, minor [slow] gastrointestinal bleeding) | Dabigatran (Pradaxa) | - Local hemostatic measures
- Possible anticoagulant discontinuation
- Half-life (normal renal function¶): 12 to 17 hours
- Possible antifibrinolytic agent (eg, tranexamic acid, epsilon-aminocaproic acid)
|
Rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Lixiana) | - Local hemostatic measures
- Possible anticoagulant discontinuation
- Half-lives (normal renal function¶):
- Rivaroxaban 5 to 9 hours
- Apixaban 8 to 15 hours
- Edoxaban 6 to 11 hours
- Possible antifibrinolytic agent (eg, tranexamic acid, epsilon-aminocaproic acid)
|