Pharmacology · single question

What is the CORRECT reversal agent for Rivaroxaban (Xarelto), a direct Factor Xa inhibitor?

  1. Vitamin K
  2. Protamine sulfate
  3. Andexanet alfa (Andexxa)
  4. Fresh frozen plasma
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Correct answer: C. Andexanet alfa (Andexxa)

Andexanet alfa (Andexxa) is the FDA-approved specific reversal agent for rivaroxaban (and apixaban) — direct Factor Xa inhibitors. It is a modified recombinant decoy Factor Xa that sequesters rivaroxaban and reverses its anticoagulant effect. Vitamin K reverses warfarin (Vitamin K antagonist). Protamine sulfate reverses heparin (and partially low molecular weight heparins). The source author guessed Vitamin K — this is incorrect. Andexanet alfa or 4-factor PCC (off-label) are the evidence-based options.

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