Contrast and compare the anti-coagulants warfarin, LMWH and the new oral anti-coagulants rivaroxaban and dabigatran with respect to their metabolism, elimination, and reversibility.
* Please check with your transfusion director regarding specific protocols for reversal of novel anti-coagulants.
| Drug | Half-Life | Elimination (Hours/Days) | Reversal |
| Warfarin | 20 to 60 hours | 5 days | Vitamin K, Prothrombin Complex Concentrates, Frozen Plasma |
| Unfractionated Heparin | 45 minutes | 4 hours | Protamine |
| LMWH | 3-6 hours (renal function) | 24 hours | Protamine |
| Dabigatran | 11-17 hours (renal function) | 1 to 3 days | Dialysis (variable results), Center dependent* (i.e. PCCs, FEIBA) |
| Rivaroxaban | 5-9 hours (renal function) | 1 to 2 days | 90% protein bound – cannot be dialyzed, Center dependent* (i.e. PCCs, FEIBA) |
Warfarin is a vitamin K antagonist, metabolized through the liver and can be reversed with vitamin K, prothrombin complex concentrates and frozen plasma.
LWMH inhibits factors Xa and IIa via accelerating the activity of ATIII. It is renally cleared and must be used with caution in patients with renal failure. Reversal can be obtained with protamine.
Rivaroxaban is an oral FXa inhibitor that is renally cleared and does not require coagulation monitoring. In cases of bleeding factor Xa levels can be used to monitor therapeutic levels. There are no approved antidotes for reversal and protocols for reversal are center dependent.
Dabigatran is an oral thrombin inhibitor that does not require coagulation monitoring. There is no reversible antidote and coagulation testing is typically not used to monitor PT/ PTT values. There are no antidotes for reversal but dialysis has been used with limited success.
