DOAC Reversal calculator
Result
Dabigatran
No reversal needed — hold and monitor
Last dose timing critical: DOACs clear within 12–24h in normal renal function.
How to use it
- 1
Time since last dose and renal function. Dabigatran: eGFR 30–50 → 36h clearance. Apixaban/rivaroxaban: ~24h normal renal function.
- 2
Idarucizumab (dabigatran). Praxbind 5g IV: licensed specific reversal. Near-complete neutralisation in < 5 min.
- 3
Andexanet alpha (Xa inhibitors). Ondexxya: licensed for apixaban/rivaroxaban. Expensive; not always available — 4F-PCC is alternative.
When to use it
- Life-threatening bleeding on DOAC
- ICH, haemothorax, haemodynamic compromise: specific reversal agent + haematology.
- Urgent surgery < 8h
- If renal function normal and last dose > 24h (Xa) or > 48h (dabigatran): surgery may proceed without reversal.
- Checking levels before reversal
- Anti-Xa level (apixaban/rivaroxaban) or dilute thrombin time/ecarin clotting time (dabigatran) quantifies DOAC burden.
A reference for clinicians and students, not medical advice. A score supports a decision; it does not make one. Check every result against the patient in front of you and your local protocol.
At a glance
- Specialty
- Pharmacology
- Inputs
- 2
- Type
- Points score
