With the arrival of a new generation of oral anticoagulants-direct factor Xa inhibitors rivaroxaban (Xarelto) and dabigatran (Pradaxa) and the direct thrombin inhibitor apixaban (Eliquis)-many of these burdens on both the patient and the healthcare system have been alleviated.

It requires close monitoring for its narrow therapeutic window, prolonged onset/offset, and variable response, all of which must be managed in the setting of several medication interactions, making it a problematic drug for both patient and physician. Annual prescriptions for warfarin number in the tens of millions as it is used for a multitude of indications including treatment/prevention of venous thromboembolism and prophylaxis in nonvalvular atrial fibrillation and cardiac-valve replacement.

Introductionįor decades the mainstay of outpatient anticoagulation has been warfarin, an inhibitor of hepatic synthesis of vitamin K dependent coagulation factors. Our case of a patient presenting to the hospital with a vaginal bleed while on rivaroxaban highlights the difficulty in management without a clear protocol or agent for reversal of anticoagulation. Nevertheless, a shortfall exists in regard to an agent or protocol for reversal of these new anticoagulants in the setting of an acute bleed. With the arrival of a new generation of oral anticoagulants significant burdens associated with warfarin’s use on both the patient and the healthcare system have been alleviated.

Xarelto antidote