Modified recombinant factor Xa decoy protein that lacks procoagulant activity and binds to direct oral Xa inhibitors, including rivaroxaban and apixaban, low-molecular-weight heparins (LMWHs), and fondaparinux. FDA-approved in 2018 for reversal of rivaroxaban and apixaban when anticoagulation reversal is necessary due to life-threatening or uncontrolled bleeding.
- Immediate onset with duration of activity of about 6 hours.
- Dosing regimens include:
- Low-dose regimen – initial IV bolus 400 mg at target rate of 30 mg/minute, followed by infusion at 4 mg/minute up to 120 minutes
- High-dose regimen – initial IV bolus 800 mg at target rate of 30 mg/minute, followed by infusion at 8 mg/minute up to 120 minutes
- Most common adverse effects include:
- Urinary tract infections
- Infusion-related reactions
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