Chart — Pharmacology
Anticoagulant Comparison Chart
Side-by-side comparison of the major anticoagulants — drug name, route of administration, monitoring parameters, reversal agent, and major risk — for rapid clinical reference and NCLEX preparation.
Educational use only. Anticoagulant dosing, monitoring, and reversal decisions are provider-ordered and individualized. Independent double-check required at most facilities. Always follow institutional anticoagulation protocols. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Anticoagulant Comparison
| Drug | Route | Monitoring | Reversal Agent | Major Risk |
|---|---|---|---|---|
| Heparin (UFH) | IV infusion or SQ | aPTT (target 60–100 sec); platelets q2–3 days | Protamine sulfate | Bleeding; HIT (paradoxical thrombosis with platelet drop >50%) |
| Enoxaparin (LMWH) | Subcutaneous | Anti-Xa if indicated; routine monitoring not required for standard dosing | Protamine sulfate (partial) | Bleeding; renal accumulation (reduce dose for CrCl <30 mL/min) |
| Warfarin | Oral | INR (target 2.0–3.0 most; 2.5–3.5 mechanical valves) | Vitamin K; FFP; 4-factor PCC | Bleeding; extensive drug/food interactions; narrow therapeutic index |
| Apixaban (Eliquis) | Oral (twice daily) | No routine lab monitoring; periodic renal function | Andexanet alfa (Andexxa) | Bleeding; no reliable standard lab test to measure anticoagulation effect |
| Rivaroxaban (Xarelto) | Oral (once or twice daily) | No routine lab monitoring; periodic renal function | Andexanet alfa (Andexxa) | Bleeding; take 10 mg+ doses with evening meal for absorption |
| Dabigatran (Pradaxa) | Oral (twice daily) | No routine monitoring; renal function q3–6 months | Idarucizumab (Praxbind) | Bleeding; GI side effects; contraindicated if CrCl <15 mL/min |
Reversal Agent Summary
| Reversal Agent | Reverses | Notes |
|---|---|---|
| Protamine sulfate | Heparin (complete); LMWH (partial ~60%) | Risk of hypotension, bradycardia, allergic reaction; slow IV push |
| Vitamin K | Warfarin | Oral or IV; takes hours to days to work; IV works faster but anaphylaxis risk |
| FFP (Fresh Frozen Plasma) | Warfarin (urgent) | Immediate but temporary; large volumes required; transfusion reactions possible |
| 4-Factor PCC (Kcentra) | Warfarin (rapid, life-threatening bleed) | Fastest reversal of warfarin; thrombosis risk |
| Andexanet alfa (Andexxa) | Apixaban, rivaroxaban (Factor Xa inhibitors) | Specific reversal agent; expensive; limited availability at some centers |
| Idarucizumab (Praxbind) | Dabigatran (direct thrombin inhibitor) | Complete reversal within minutes; humanized monoclonal antibody fragment |
HIT — Quick Recognition Guide
What: Heparin-Induced Thrombocytopenia — immune-mediated adverse effect. Platelet activation causes paradoxical thrombosis despite low platelets.
When: Typically 5–14 days after heparin exposure
Recognize: Platelet count drop >50% from baseline + new or worsening thrombosis
Action: Stop ALL heparin immediately (including flushes). Do not give platelets. Switch to argatroban or fondaparinux (provider ordered).
NCLEX tip: HIT = stop ALL heparin products. Do not transfuse platelets in HIT.
NCLEX Quick Tips
- Heparin → monitor aPTT. Warfarin → monitor INR. DOACs → no routine monitoring.
- Heparin reversal = protamine sulfate. Warfarin reversal = vitamin K. Dabigatran reversal = idarucizumab (Praxbind). Factor Xa inhibitor reversal = andexanet alfa.
- INR target for most: 2.0–3.0. For mechanical heart valves: 2.5–3.5.
- HIT: platelet drop >50% + thrombosis → stop ALL heparin products immediately
- Enoxaparin — do not expel air bubble before injecting; do not rub after; reduce dose in renal impairment
- Warfarin — consistent vitamin K diet; many drug interactions; delayed onset (2–5 days)
- Dabigatran — do not crush capsules; take with food; renal clearance — contraindicated with severe renal impairment
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with ACCP / ISTH / ISMP Guidelines. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →