Reversal of Apixaban and Rivaroxaban: Evidence for Fixed-Dose vs Weight-Based Dose of Prothrombin Complex Concentrate
by Anastasia E. Boutris, 2026 PharmD Candidate, Christina D. Choi, 2026 PharmD Candidate, Maura C. Keenan, 2026 PharmD Candidate
Abstract:
Reversing anticoagulation in emergency situations is crucial but challenging, as it requires selecting the correct agent and dosage based on the specific circumstances. Direct factor Xa inhibitors, such as rivaroxaban and apixaban, require either andexanet alfa or prothrombin complex concentrate (PCC) for reversal. For PCC administration, evidence supports both fixed dosing and weight-based dosing. This literature review’s findings suggest that a fixed dosing of PCC is non-inferior to the weight-based dose. Furthermore, utilizing a fixed dose may improve patient outcomes, enhance safety, and streamline administration.
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2025 September/October Table of Contents
Abstract:
Reversing anticoagulation in emergency situations is crucial but challenging, as it requires selecting the correct agent and dosage based on the specific circumstances. Direct factor Xa inhibitors, such as rivaroxaban and apixaban, require either andexanet alfa or prothrombin complex concentrate (PCC) for reversal. For PCC administration, evidence supports both fixed dosing and weight-based dosing. This literature review’s findings suggest that a fixed dosing of PCC is non-inferior to the weight-based dose. Furthermore, utilizing a fixed dose may improve patient outcomes, enhance safety, and streamline administration.
Download PDF
2025 September/October Table of Contents