A patient with non-valvular AF on rivaroxaban requires urgent surgery within 8 hours. Which reversal agent specifically targets rivaroxaban and apixaban?
- A Idarucizumab (humanized monoclonal antibody Fab fragment)
- B Ciraparantag (PER977, broad-spectrum small molecule reversal agent)
- C Andexanet alfa (recombinant modified factor Xa decoy protein) ✓
- D 4-factor prothrombin complex concentrate (4F-PCC)
Explanation
Andexanet alfa is a recombinant modified human factor Xa decoy protein (catalytically inactive) that binds and sequesters factor Xa inhibitors (rivaroxaban, apixaban, edoxaban, betrixaban) with high affinity, rapidly reversing anticoagulation. Idarucizumab is a Fab fragment that specifically reverses dabigatran (direct thrombin inhibitor), not factor Xa inhibitors. Ciraparantag is an investigational broad-spectrum reversal agent. 4F-PCC can provide hemostatic support but is not a specific antidote; it provides additional clotting factors rather than binding and neutralizing the anticoagulant.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.