(Section 4.1. in the 2014 AF Guideline) I B-NR Idarucizumab is recommended for the reversal of dabigatran in the event of life-threatening bleeding or an urgent NEW: New evidence has been published about idarucizumab to support LOE B-NR. IIa B-NR Andexanet alfa can be useful for the reversal of rivaroxaban and apixaban in the event of life- threatening or uncontrolled bleeding.S4.3-3,S4.3-4 NEW: New evidence has been published about andexanet alfa to support LOE B-NR. Recommendation-Specific Supportive Text (New or Modified) 2. The BRIDGE (Bridging Anticoagulation in Patients who Require Temporary Interruption CLINICAL STATEMENTS AND GUIDELINES of Warfarin Therapy for an Elective Invasive Procedure or Surgery) study was a randomized, double-blind, placebo-controlled trial of bridg- ing versus no bridging in 1 884 patients with AF (except with moderate to severe mitral stenosis or a mechanical heart valve) requiring peripro- cedural interruption of warfarin therapy.S4.3-1 Absence of bridging was found to be noninfe- rior to bridging with low-molecular-weight hep- arin for prevention of arterial thromboembolism and was found to decrease the risk of bleeding. Bridging anticoagulation may be appropriate only in patients (on warfarin) with a very high thromboembolic risk. 3. The analysis of 503 patients from the RE-VERSE AD (Reversal Effects of Idarucizumab on Active Dabigatran) trial found that idarucizumab, a monoclonal antibody fragment that binds dabig- atran, rapidly normalized hemostasis and reduced levels of circulating dabigatran in subjects on dab- igatran who had serious bleeding or required an Idarucizumab has received full FDA approval. 4. Andexanet alfa (coagulation factor Xa [recom- binant], inactivated-zhzo) is a bioengineered, recombinant modified protein designed to serve as an antidote against direct factor Xa inhibitors. It was reported to reverse the effects of rivaroxaban and was approved under the FDA s accelerated-approval pathway on the basis of effects in healthy volunteers. 