Original Article In vitro reversal of supratherapeutic rivaroxaban levels with coagulation factor concentrates Mareike K. Körber1, Elisabeth Langer2,3, Lutz Kaufner1, Michael Sander4, Christian von Heymann1,5 Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin; 2Labor Berlin - Charite Vivantes GmbH, Berlin; 3Institute for Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin; 4 Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Giessen-Marburg; 5Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, "Vivantes Netzwerk für Gesundheit GmbH Klinikum im Friedrichshain", Berlin, Germany 1

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Background. A bleeding patient undergoing therapy with new oral anticoagulants is every clinician's nightmare as no specific reversal agent is available yet. This in vitro study investigated the effect of prothrombin complex concentrate (PCC), recombinant activated factor VII (rFVIIa) and activated prothrombin complex concentrate (aPCC) on supratherapeutic rivaroxaban concentrations using standard laboratory parameters (prothrombin time [PT], activated partial thromboplastin time [aPTT] and PT ratio) and thromboelastometry (clotting time [CT]). Materials and methods. Blood samples from 10 healthy volunteers were collected and spiked with a supratherapeutic dose of rivaroxaban. Afterwards PCC, rFVIIa and aPCC were added in two doses. The laboratory parameters were measured and thromboelastometry was performed. Results. The addition of the reversal agents had the following statistically significant effects (all p