How do I manage a bleed with XARELTO®? Is there a reversal agent for XARELTO®?

XARELTO® increases the risk of bleeding and can cause serious or fatal bleeding. Concomitant use of drugs affecting hemostasis increases the risk of bleeding. An agent to reverse the anti-factor Xa activity of rivaroxaban is available.

Promptly evaluate any signs or symptoms of blood loss and consider the need for blood replacement. Discontinue XARELTO® in patients with active pathological hemorrhage. XARELTO® has a half-life of approximately 5 to 9 hours in healthy subjects aged 20 to 45 years and 11 to 13 hours in the elderly.

Partial reversal of prothrombin time prolongation has been seen after administration of PCCs in healthy volunteers. The use of procoagulant reversal agents like aPCC or rFVIIa has not been evaluated.

For VTE prophylaxis in acutely ill medical patients at risk for thromboembolic complications who are not at high risk of bleeding.

aPCC = activated prothrombin complex concentrate; PCC = prothrombin complex concentrate; rFVIIa = recombinant factor VIIa.

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