ToxicologyEmergencyHaematology
DOAC overdose / reversal
Reversal of life-threatening bleeding from DOACs — idarucizumab for dabigatran, andexanet alfa or PCC for factor Xa inhibitors.
Source: BSH 2018; ESC 2021; TOXBASE/NPIS; SmPC Praxbind/Ondexxya
Step 1 of ~8
action
Identify the agent and timing
Identify exact DOAC, last dose time, dose, indication, renal/hepatic function. Co-medications (antiplatelets, NSAIDs).
DOACs:
• Dabigatran (direct thrombin inhibitor) → idarucizumab
• Apixaban / rivaroxaban / edoxaban (factor Xa inhibitors) → andexanet alfa or 4-factor PCC
ABCDE; large-bore IV access x2; group & save / cross-match; bloods: FBC, U&E, creatinine, LFTs, fibrinogen, INR (insensitive for DOACs), APTT (raised in dabigatran), thrombin time (very sensitive for dabigatran), anti-Xa level if available, lactate, VBG.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Drugs
- Idarucizumab (Praxbind)RecommendedDabigatran reversal agent (specific antidote)
- Andexanet AlfaRecommendedFactor Xa Reversal Agent
- ApixabanRecommendedDirect oral anticoagulant (DOAC) — Factor Xa inhibitor
- Edoxaban (AF Stroke Prevention / VTE)RecommendedDirect Factor Xa Inhibitor (DOAC)
- Dabigatran etexilateRecommendedDirect thrombin (factor IIa) inhibitor (DOAC)
Same class
Pathways
- Paracetamol overdose · TOXBASE/NPIS; MHRA DSU 2012/2024; SNAP regimen (Lancet 2014); BNF
- TCA overdose · TOXBASE/NPIS; AACT/EAPCCT position statements; Resuscitation Council UK ALS
- Opioid overdose · TOXBASE/NPIS; Resuscitation Council UK; BNF
- Anticholinergic toxidrome · TOXBASE/NPIS; AACT/EAPCCT; BNF
- Benzodiazepine overdose · TOXBASE/NPIS; AACT/EAPCCT; BNF
- β-blocker overdose · TOXBASE/NPIS; AACT/EAPCCT; ESC; BNF
Decision support only. Always apply local guidelines and clinical judgement.