A 68-year-old woman with AF on rivaroxaban (DOAC) requires emergency reversal for life-threatening intracranial hemorrhage. The CORRECT reversal agent is:

• A Andexanet alfa ✓
• B Idarucizumab
• C Protamine sulfate
• D Vitamin K

Explanation

Andexanet alfa is a modified recombinant Factor Xa decoy protein approved for reversal of Factor Xa inhibitors—rivaroxaban and apixaban. It acts as a competitive sequestering agent, binding Factor Xa inhibitors with high affinity and thereby neutralizing their anticoagulant effect. Idarucizumab is a monoclonal antibody fragment that specifically reverses dabigatran (a direct thrombin inhibitor), not Factor Xa inhibitors. Protamine sulfate reverses unfractionated heparin (and partially LMWH). Vitamin K reverses warfarin. If andexanet alfa is unavailable, 4F-PCC may be used as an alternative for Factor Xa inhibitor reversal.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.