Reversal of direct oral anticoagulants

Figures & data

Table 1 Summary of specific reversal agents for DOACs

	Idarucizumab	Andexanet alfa	Ciraparantag
Target	Thrombin inhibitor (dabigatran)	Direct factor Xa inhibitors (rivaroxaban, apixaban, edoxaban), LMWH, fondaparinux	Dabigatran, rivaroxaban, apixaban, edoxaban, LMWH, fondaparinux
Mechanism of action	Noncompetitive binding to dabigatran	Binding to direct and indirect factor Xa inhibitors	Noncovalent hydrogen bonding binds to the target drug
Onset of action	Immediate	2–5 minutes	10 minutes
Administration and dose	5 g intravenously as two doses of 2.5 g each, not more than 15 minutes apart*	400–800 mg intravenous bolus followed by 4–8 mg/min infusion§	100–300 mg intravenous bolus±
Elimination	Renal	Not reported	Not reported

Notes:

* FDA-approved dose.

§ Doses used in clinical trials but not approved.

± Dose used in Phase I clinical trial.

Abbreviations: DOACs, direct oral anticoagulants; FDA, US Food and Drug Administration; LMWH, low molecular weight heparin.