Rivaroxaban Reversal Agent — NDEB AFK MCQ

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HardPharmacologyRivaroxaban Reversal AgentNDEB AFK

A patient currently taking rivaroxaban (a DOAC/factor Xa inhibitor) develops severe uncontrolled post-extraction haemorrhage. Which reversal agent is specifically indicated?

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Reveal the answer and explanation

Correct answer: C — Andexanet alfa (factor Xa reversal agent)

Andexanet alfa is a modified recombinant factor Xa protein that acts as a decoy receptor, binding and sequestering factor Xa inhibitors (rivaroxaban, apixaban) and reversing their anticoagulant effect. It is FDA/Health Canada-approved for reversal of life-threatening or uncontrolled bleeding in patients on factor Xa inhibitors. Idarucizumab (Praxbind) reverses dabigatran (direct thrombin inhibitor) specifically. For most dental bleeding, local haemostatic measures (sutures, tranexamic acid, oxidised cellulose) are sufficient without systemic reversal.

Reference: Katzung – Basic and Clinical Pharmacology, 15th ed., 2021