From the Guidelines
No, Fresh Frozen Plasma (FFP) is not recommended to counteract the anticoagulant effects of Eliquis (apixaban). For urgent reversal of Eliquis, the specific antidote Andexxa (andexanet alfa) is the preferred agent, as recommended by the 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage 1.
Key Points to Consider
- FFP contains insufficient concentrations of clotting factors to effectively reverse direct oral anticoagulants like Eliquis and would require impractically large volumes to have any meaningful effect.
- FFP carries risks including fluid overload, transfusion reactions, and potential disease transmission.
- The use of specific reversal agents such as andexanet alfa for factor Xa inhibitors like Eliquis is supported by guidelines 1.
- In emergency situations where Andexxa is unavailable, prothrombin complex concentrate (PCC) may be used as an alternative, as suggested by the guidelines 1.
Clinical Considerations
- If you're concerned about bleeding risk with Eliquis, the best approach is to contact a healthcare provider immediately, as they can assess the situation and determine the appropriate reversal strategy based on the urgency, severity of bleeding, and available resources.
- The management of anticoagulant-associated bleeding requires a prompt and tailored approach, taking into account the type of anticoagulant, the severity of bleeding, and the patient's clinical condition, as emphasized in the guidelines 1.
From the Research
Reversal of Eliquis (Apixaban) with Fresh Frozen Plasma (FFP)
- The use of FFP to reverse the anticoagulant effect of Eliquis (apixaban) is not recommended, as stated in a study published in 2019 2.
- According to a 2018 review, FFP is not considered an optimal choice for reversing the anticoagulant effect of novel oral anticoagulants, including apixaban 3.
- A 2015 review also suggests that FFP may not be effective in reversing the anticoagulant effect of factor Xa inhibitors, including apixaban 4.
Alternative Reversal Agents for Eliquis (Apixaban)
- Andexanet alfa, a modified decoy form of activated factor X, has been approved for reversing the anticoagulant effect of apixaban and rivaroxaban in patients with major bleeding 3, 5.
- Prothrombin complex concentrates (PCCs) have been suggested as an alternative for reversing the anticoagulant effect of apixaban in patients with life-threatening bleeding 2, 6.
- Activated prothrombin complex concentrate (aPCC) has been shown to effectively reverse the anticoagulant effect of apixaban in a case series of patients undergoing emergency cardiovascular surgery 6.