| Anticoagulant | Reversal agent | Dose |
|---|---|---|
| Warfarin (life-threatening bleed) | 4-Factor PCC (Kcentra) + Vitamin K | INR 2-<4: 25 units/kg • INR 4-6: 35 units/kg • INR >6: 50 units/kg (max 5000 units) + Vit K 10 mg IV |
| Warfarin (non-emergent) | Vitamin K (Phytonadione) | 1-10 mg PO/IV depending on INR and bleeding |
| Dabigatran (Pradaxa) | Idarucizumab (Praxbind) | 5 g IV (two 2.5 g vials) |
| Apixaban / Rivaroxaban | Andexanet alfa (Andexxa) or 4F-PCC | Andexxa: low/high dose per last dose & timing • 4F-PCC: 50 units/kg (off-label) |
| Unfractionated Heparin | Protamine sulfate | 1 mg per 100 units heparin given in last 2-3 hr (max 50 mg/dose) |
| LMWH (Enoxaparin) | Protamine sulfate | 1 mg per 1 mg enoxaparin if <8 hr; 0.5 mg per 1 mg if 8-12 hr |
| Antiplatelet (ASA/Clopidogrel) | Platelet transfusion (selected cases) | 1 apheresis unit; consider DDAVP 0.3 mcg/kg IV |
| tPA / Thrombolytic | Cryoprecipitate ± TXA | 10 units cryoprecipitate; TXA 1 g IV over 10 min |