In 3 small (12-93 patients) randomized, placebo-controlled studies, PCC reversed the anticoagulant effect of rivaroxaban and edoxaban but There was a dose-dependent relationship with complete reversal with 50 U/kg and partial reversal with 25 U/kg. It is unclear whether normalizing coagulation parameters in healthy volunteers translates to improved outcomes in patients who are actively bleeding. Furthermore, the use of these agents in managing bleeding caused by VKA or in hemophiliac patients has been associated with an increased risk of thrombotic complications, especially when activated factors are Speci c Reversal Agents: Idarucizumab: Idarucizumab is a humanized monoclonal antibody fragment developed as a speci c reversal agent for dabigatran It binds with high af nity (350 times higher than thrombin) to free and thrombin-bound and binding is effectively irreversible.227 The Reversal Effects of Idarucizumab on Active Dabigatran (RE-VERSE AD) study was a phase 3, global, prospective, cohort study investigating the safety and ef cacy of 5 g idarucizumab (administered as two rapid 2.5 g IV boluses) in dabigatran-treated patients who present with uncontrolled or life-threatening bleeding (Group A) or non-bleeding patients who require emergent surgery or intervention (Group B).228 Idarucizumab resulted in immediate, complete, and sustained reversal of dabigatran. Median time to cessation of bleeding in Group A was between 2.5 h after reversal and in Group B, median time to surgery after reversal was 1.6 h with intraoperative hemostasis deemed normal by investigators in 93.4% of patients. Idarucizumab has worldwide approval and availability. Andexanet Alfa: Andexanet alfa (andexanet) is a speci c reversal agent for direct (apixaban, rivaroxaban, and edoxaban) and indirect (low-molecular-weight heparins [LMWHs] and fondaparinux) factor Xa inhibitors that act through antithrombin. 