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Pathology and Laboratory Medicine
Transfusion Essentials

Guidelines for Management of Severe Bleeding Associated with Direct Anticoagulant (DOAC) Agents using Coagulation Factor Concentrates

  • ​Severe or life-threatening bleeding in patients receiving direct oral anticoagulant (DOAC) medications, including:
    • Factor Xa inhibitors (apixaban (Eliquis®)), rivaroxaban (Xarelto®), edoxaban (Lixiana®))
    • Direct thrombin inhibitors (dabigatran (Pradaxa®))
  • Coagulation factor concentrates recommended may help temporize bleeding in situations of severe or life-threatening DOAC associated bleeding, but are NOT true reversal agents of these medications
  • Consultation with the Transfusion Medicine Physician is strongly recommended for management of DOAC associated bleeding, particularly if coagulation factor concentrate use is being considered
  • Consider use of Tranexamic Acid 10 mg/kg IV
  • Administration of coagulation factor concentrates for DOAC associated bleeding is an off-label use of products listed
  • Maximum dose of not to exceed 3000 IU for Beriplex®/Octaplex®
AnticoagulantManagement Strategy
​apixaban (Eliquis®)​Beriplex®/Octaplex® 25-50 IU/kg x 1
​rivaroxaban (Xarelto®)
​edoxaban (Lixiana®)
​dabigatran (Pradaxa®) Praxbind® (idarucizmab)*

* The reversal agent of dabigatran (Pradaxa®) called idaracizumab (Praxbind®) is now available at the Saskatoon urban site Emergency Departments (RUH, SPH, SCH) via the hospital Pharmacy. Contact Pharmacy for further information.

Preparation and Administration

Beriplex®/Octaplex® (Prothrombin Complex Concentrates(PCC)):

  • ​ ​Laboratory investigations may be used to confirm the absence of clinically significant DOAC presence in the patient circulation (if results are in the normal range, this indicates the drug is not present):
AnticoagulantCoagulation Laboratory Test to Order
​apixaban (Eliquis®)Anti-Xa level (also called the Heparin Level)​
​rivaroxaban (Xarelto®)
​edoxaban (Lixiana®)
​dabigatran (Pradaxa®)Thrombin time (TT)
  • Depending on the DOAC present, baseline TT or Anti-Xa should be drawn to evaluate the degree of anticoagulation, in addition to INR, PTT and fibrinogen
  • Beriplex®/Octaplex® are not reversal agents for factor Xa inhibitor medications, and results of repeat testing post-administration may not correct to levels within the normal range
  • Repeat dosing of coagulation factor concentrates is not recommended for management of DOAC associated bleeding
  • The presence of renal failure may prolong medication clearance and DOAC anticoagulation effect
  • Adverse reactions associated with Beriplex®/Octaplex® administration including immediate allergic complications are rare. Thrombosis risk is at least 1 in 100, and dependent on individual patient risk factors and product dose. 

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Laboratory Controlled Document JA-211 v3

Last Modified: Monday, February 3, 2020 |
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