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Is There an Antidote for Xarelto or Eliquis Bleeding?

Anticoagulants prevent blood clots but raise the risk for bleeding, especially during emergency surgery. Is there an antidote for Xarelto in a crisis?

It used to be that if someone were taking an anticoagulant to prevent blood clots there wasn’t much that could be done if the patient began bleeding badly. That is probably why Johnson & Johnson and Bayer agreed to settle nearly 25,000 Xarelto lawsuits for a total of $775 million. Now there is an antidote for Xarelto and Eliquis.

This Reader Worries About Xarelto and Surgery:

Q. Is it still true that people can bleed to death if they need emergency surgery while taking the anticoagulant Xarelto? Is there anything being done about it?

A. You raise a critical question. New-generation anticoagulants such as rivaroxaban (Xarelto) and apixaban (Eliquis) carry a risk of bleeding under the best of conditions. If a patient requires emergency surgery, the possibility of hemorrhage is even greater.

An Antidote for Xarelto (and Eliquis):

Fortunately, emergency physicians and surgeons now have an antidote called andexanet alfa (Andexxa). This intravenous drug can help reverse the anticoagulation effect of Eliquis and Xarelto when patients are faced with uncontrolled bleeding.

Emergency physicians can learn more about dealing with this kind of crisis in the publication Critical Pathways in Cardiology (Sept. 2019).  It is important for people taking such anticoagulants to know when they might need to take immediate precautionary action.

Here is what the official FDA prescribing information tells doctors:

“Advise patients to report any unusual bleeding or bruising to their physician. Inform patients that it might take them longer than usual to stop bleeding, and that they may bruise and/or bleed more easily when they are treated with XARELTO

“Instruct patients to inform their healthcare professional that they are taking XARELTO before any invasive procedure (including dental procedures) is scheduled.

“Advise patients to inform their physicians and dentists if they are taking, or plan to take, any prescription or over-the-counter drugs or herbals, so their healthcare professionals can evaluate potential interactions

“Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary 

Remind patients to not discontinue XARELTO without first talking to their healthcare professional.”

People’s Pharmacy Xarelto Caution:

If you notice that your gums are bleeding after brushing or flossing, let your health professional know promptly. If you cut yourself and the bleeding won’t stop within a reasonable amount of time, let your health professional know promptly. If you start developing nosebleeds let your health professional know promptly. If you see blood in your urine, let your health professional know promptly.

Do you see a pattern here? If you see red, contact your doctor! If you experience a serious bleeding episode, get to an emergency department pronto. Remember, there is an antidote for Xarelto and Eliquis. There is also an antidote for Pradaxa (dabigatran). It is called Praxbind (idarucizumab).

Learn more about adverse reactions related to both Eliquis and Xarelto at this link:

Some Eliquis and Xarelto Side Effects NOT in the Prescribing Info

Share your own experience with Xarelto or Eliquis in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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