Bleeding Considerations

Warfarin (Coumadin) Dabigatran (Pradaxa) Apixaban (Eliquis) Edoxoban (Savaysa) Rivaroxaban (Xarelto)
Anticoagulant mechanism Vitamin K antagonist Thrombin inhibitor Factor Xa inhibitor Factor Xa inhibitor Factor Xa inhibitor
Half-life Variable 12-17h 12h 10-14h 5-9h
Recommended therapy cessation prior to a low risk procedure 5 days 1-2d (CrCL>50)
3-5d (Crcl<50)
24h 24h 24h
PT/INR can accurately assess anticoagulation state Yes No No No No
Test result indicating lack of anticoagulation Normal PT/INR Normal aPTT Normal factor Xa Normal factor Xa Normal factor Xa
Rapid reversal agent Multiple, including fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC) Idarucizumab (Praxbind) Not yet available* Not yet available* Not yet available*
Reversal agent mechanism Replacement of depleted coagulation factors Humanized monoclonal antibody targeted to dabigatran
Reversal agent dosing Product dependent 5g IV

*consider PCC usage on a case by case basis as there is no prospective outcomes data for use of PCC agents for Xa inhibitor reversal