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How do you reverse bleeding with Xarelto?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 29, 2025.

Official Answer by Drugs.com

Andexxa injection is an antidote that can be used for patients being treated with rivaroxaban (Xarelto) or apixaban (Eliquis) when reversal of anticoagulation (blood thinning) is needed due to life-threatening or uncontrolled bleeding.

Andexxa (coagulation factor Xa), from Portola Pharmaceuticals, is a Factor Xa inhibitor reversal agent approved in 2018. It is an altered form of the human Factor Xa (10a) molecule, a human enzyme that helps blood to clot and lowers the risk from serious bleeding from Xa inhibitors. It is given as an intravenous (IV) injection.

The most common side effect with Xarelto is bleeding. You may bruise easily or take longer to stop bleeding from a minor cut.

Get medical help immediately if you have:

Vitamin K is often used to reverse bleeding from warfarin but doesn't work for drugs like Xarelto.

How does Andexxa work to stop bleeding?

Andexxa works by acting as a trap for oral and injectable Factor Xa inhibitors, binding to the drug to reverse the anticoagulant effect. It ​​neutralizes the anticoagulant effect of Xarelto (rivaroxaban). Andexxa is also approved to reduce the anticoagulant effect of Factor Xa inhibitor Eliquis (apixaban).

The most common adverse reactions (side effects) with Andexxa were:

Andexxa can cause serious or life-threatening side effects, including the development of blood clots. Talk to your doctor about when to restart your blood thinner medication to help reduce the risk of a blood clot formation.

Andexxa is given in 2 parts as a bolus first (an injection that gets the medicine into your bloodstream quickly) and as an infusion second (slowly adds the medicine to your bloodstream over time. It is given only by your doctor or other healthcare provider.

This is not all the information you need to know about Andexxa and does not take the place of your doctor’s directions. Discuss any medical questions you have with your doctor or other health care provider.

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Switching from Eliquis to Xarelto: What do I need to know?

Follow your healthcare provider's instructions when switching from Eliquis to Xarelto. When switching from Eliquis to Xarelto you should stop taking Eliquis and then start taking Xarelto at the time your next dose of Eliquis is due. Do not take Eliquis and Xarelto at the same time. Continue reading

Does Feverfew interact with any drugs?

Feverfew, an herbal supplement that is a member of the daisy family, may interact with over 40 medicines. This includes drugs used to help prevent blood clots like the anticoagulant warfarin. Continue reading

How does Xarelto work?

Xarelto (rivaroxaban) works by blocking a blood protein called clotting Factor Xa (10a) that helps to stop bleeding. This action can keep blood clots from developing or getting worse. Continue reading

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