Andexanet Alfa Rivaroxaban — ORE Part 1 MCQ
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Correct answer: C — Andexanet alfa
The answer is **A. Andexanet alfa**. It is the specific reversal agent for rivaroxaban, a direct factor Xa inhibitor. NICE identifies andexanet alfa as an agent that reverses anticoagulation from rivaroxaban (and apixaban), although its routine NHS recommendation is limited to defined life-threatening or uncontrolled gastrointestinal bleeding; a patient with major post-extraction bleeding requires urgent hospital-based escalation rather than routine dental prescribing. Idarucizumab reverses dabigatran, a direct thrombin inhibitor. Vitamin K reverses warfarin-mediated reduction in vitamin K-dependent clotting factors and does not reverse rivaroxaban. Protamine mainly neutralises unfractionated heparin. Fresh frozen plasma is not a specific antidote and does not directly neutralise a factor Xa inhibitor.
Reference: National Institute for Health and Care Excellence. Andexanet alfa for reversing anticoagulation from apixaban or rivaroxaban (TA697), Recommendations, updated 15 January 2025. https://www.nice.org.uk/guidance/ta697/chapter/1-Recommendations