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An Rx vial: Eliquis reversal
Drug Info

How to reverse Eliquis?

Andexxa works as a reversal agent to treat uncontrollable bleeding for those taking Eliquis
Rebecca Rovenstine writer headshot
By | Jun. 27, 2024 Medically reviewed by J. Elizabeth Allen, DO, FACEP

Key takeaways

  • Andexxa (Andexanet alfa) is given as a reversal agent for Eliquis.

  • Bleeding can become life-threatening due to Eliquis, which is why there is a need for these reversal agents.

  • There is only one FDA-approved Eliquis (apixaban) reversal treatment on the United States market.

In this article:

Eliquis, sold under the generic name apixaban, is a Factor Xa inhibitor, which is more commonly referred to as a direct oral anticoagulant (DOAC) or blood thinner. Factor Xa is an enzyme that is involved in the formation of blood clots. Eliquis works by binding to the active site of Factor Xa and blocking the progression of the clotting cascade. This medication is used to treat blood clots and to help prevent them from forming. However, when someone on Eliquis has an injury that causes bleeding, this life-saving drug can quickly become life-threatening, as clotting is a crucial part of stopping bleeding. 

Luckily, there is an Eliquis reversal agent called Andexxa (andexanet alfa) that has been approved to treat uncontrollable bleeding for those on Eliquis (apixaban) and Xarelto (rivaroxaban). 

Continue reading to learn what the experts say about this new medication.

How to reverse Eliquis?

“While Eliquis can be a life-saving medication that is prescribed to prevent dangerous blood clots from forming, it also has side effects,” states Dr. Nieca Goldberg, a board-certified cardiologist who currently works as a Clinical Associate Professor of Medicine at NYU Grossman School of Medicine.

When someone on Eliquis has a life-threatening case of bleeding, reversal agents are given specifically for this purpose. Reversal agents are given as intravenous infusions, and the procedure is performed in a hospital or Emergency Department (ED) under the supervision of a healthcare professional. 

“To put this into context, if a person who is on Eliquis has sustained an injury to the chest (for example, after a motor vehicle accident), this may cause serious bleeding around major organs like the heart and may require life-saving surgery,” explained Dr. Goldberg. “In this situation, a reversal agent may be administered. These reversal medications are important tools but may increase the risk of blood clots (which is what Eliquis is typically prescribed to prevent).”

Apart from traumatic events and accidents, surgeries and invasive procedures also pose potential risks of excessive bleeding for individuals taking Eliquis.

“In planned surgeries, Eliquis would typically just be stopped within an appropriate time frame before the surgery, but in unplanned or emergency surgeries, a reversal agent might be necessary,” explained Christopher Norman, a Nurse Practitioner with the National Council on Aging. “Since Eliquis is a blood thinner, reversing its effects can help control the risk of bleeding, making it safer for patients who need surgery.”

This is more than just an issue with Eliquis. Any blood-thinning medications, such as direct oral anticoagulants or vitamin K antagonists, such as warfarin, can lead to life-threatening bleeding. The approach to reversing blood-thinning medications depends on the type of medication taken. Only one of the direct oral anticoagulant medications (dabigatran) has a specific antidote. 

What drugs reverse the effects of Eliquis?

Andexanet alfa, sold under the brand name Andexxa, is one of the primary drugs to reverse the effects of Eliquis.

Andexanet alfa is an engineered substance that is so similar to the natural form of factor Xa that it acts as a decoy to medications like Eliquis. The Eliquis attaches to the decoy (andexanet alfa) instead of the natural factor Xa so that the body can start forming blood clots again. 

Andexxa must be given as an infusion under the supervision of a healthcare provider. The dosage will depend on the amount of the patient’s last dose of Eliquis. 

Another promising reversal agent for blood thinners is Kcentra, a four‐factor prothrombin complex concentrate (4F‐PCC). Many studies have looked into Kcentra for Eliquis treatment. However, Kcentra’s clinical trials excluded individuals on Factor Xa inhibitors, so the U.S. Food and Drug Administration (FDA) has not approved using this medicine as an Eliquis reversal agent.

Many studies have demonstrated that 4F-PCC helps to counteract the effects of blood thinning medications and helps stop life-threatening or uncontrolled bleeding. Unfortunately, there is also a risk of blood clots forming after the administration of this medication. 

How quickly does an Eliquis reversal agent begin to take effect?

Because everyone’s body processes medications differently, the time it takes for an Eliquis reversal agent to take effect can vary from person to person. Andexanet alfa can begin working in two to five minutes. It can take up to two hours for Andexxa to completely stop the effects of Eliquis.