This page is a clinical decision support draft. The accompanying Trust SOP, decision-engine specification, evidence table, validation framework, and governance pack are under review and have not yet been ratified. Use clinical judgement, follow local policy, and discuss life-threatening reversal decisions with the Consultant Haematologist on-call.
Anticoagulant Reversal Calculator
Unified calculator for DOACs, vitamin K antagonists, heparins, and fondaparinux. Working draft companion to the proposed Trust algorithm. Andexanet alfa SmPC dose-selection logic verified against the Ondexxya SmPC (medicines.org.uk, last updated 5 March 2026) on 6 May 2026.
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This tool is a working draft companion to the proposed Trust algorithm and does not replace clinical judgement, the SmPC, or the Consultant Haematologist on-call. PCC use for factor Xa inhibitor reversal is off-label in the UK. Andexanet alfa is licensed in adults for life-threatening or uncontrolled bleeding on apixaban or rivaroxaban (Ondexxya SmPC, EMC, last updated 5 March 2026). UK commissioning is divided by nation, verified live on 8 May 2026: England follows NICE TA697 (15 January 2025) — GI bleed only; Wales defers to NICE TA697 via AWMSG/AWTTC reference 2409 (06 June 2019, excluded from appraisal under criterion 10) — GI bleed only; Northern Ireland per Department of Health NI endorsement of NICE TA697 (June 2021) — GI bleed only; Scotland per SMC advice 2273 (07 September 2020) — accepted for the full licensed indication on an interim basis (any site). NICE TA1029 (15 January 2025) is a terminated appraisal — no NICE recommendation for andexanet alfa in intracranial haemorrhage in E/W/NI. Each application is an individual clinical decision by the responsible Consultant. Andexanet alfa SmPC dose-selection logic and idarucizumab regimen verified against primary sources on 6 May 2026; four-nation commissioning verified 8 May 2026.