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. It is a modi ed human recombinant factor Xa decoy protein that is catalytically inactive due to replacement of an active-site serine with alanine and with deletion of the membrane binding domain, which eliminates the ability to assemble the prothrombinase complex. Andexanet retains the ability to bind to NOACs with high af nity and a 1:1 stoichiometric ratio and by sequestering factor Xa inhibitors within the vascular space, endogenous factor Xa activity is restored.229 Due to its pharmacodynamic half-life of 1 h, andexanet is administered as a bolus followed by an infusion. is evaluating the ef cacy and safety of andexanet in patients taking factor Xa inhibitors with acute major bleeding. Unlike RE-VERSE AD, this study does not include patients without bleeding but who require emergency or urgent procedures. A preliminary interim analysis of 67 patients demonstrated that an initial bolus and subsequent 2-h infusion of andexanet substantially reduced anti-factor Xa activity with clinically adjudicated effective hemostasis occuring in 79% of Andexanet is in late-stage review by regulatory authorities. Ciraparantag (PER977): Ciraparantag is a small synthetic water-soluble molecule developed as a reversal agent for unfractionated heparin (UFH), LMWHs, fondaparinux, and the oral direct Xa and IIa inhibitors. 