Pharmacists,

We are now using FEIBA as approved by the P&T Committee this fall. FEIBA will be replacing Kcentra for patients with anticoagulant-related bleeding. The order set we will use for FEIBA is attached to this email and also available on FormWeb. I have included information about FEIBA below for ease of reference.

1. FEIBA should be used in emergent life-threatening bleeding in which reversal of anticoagulation is necessary to:
1. Stop an active bleed
2. Perform an emergent procedure in which bleeding is of concern

1. **Kcentra is preferred prothrombin complex concentrate (PCC) product for life-threatening bleeding unrelated to oral anticoagulant therapy.**
1. FEIBA is the agent of choice for emergent bleeding related to:
1. Warfarin (COUMADIN)
2. Apixaban (ELIQUIS)
3. Rivaroxaban (XARELTO)
4. Edoxaban (SAVAYSA)
5. Betrixaban (BEVYXXA)
2. FEIBA is an additional or alternative option for emergent bleeding related to Dabigatran (PRADAXA). Can be used in addition or as alternative to Praxbind.
3. Dosing:
1. Warfarin - Dependent on INR, NOT dependent on weight or indication
• INR < 5 - Give FEIBA 500 units
• INR > 5 - Give FEIBA 1,000 units
• **These doses may be repeated if necessary**
2. Apixaban, Rivaroxaban, Edoxaban, Dabigatran - Dependent on weight and indication
• Intracranial Hemorrhage - FEIBA 50 units/kg, MAX 5,000 units
• All Other Bleeding - FEIBA 30 units/kg, MAX 3,000 units
4. iCare
1. Enter FEIBA dose into iCare with desired dose
2. Like other blood factor products, each vial is standardized in nominal units (2,500 units/vial), but each vial varies in the exact number of units it contains.
• A nominal vial of 500 units may contain anywhere from 350 - 650 units per vial
• A nominal vial of 1,000 units may contain anywhere from 700 - 1,300 units per vial
• A nominal vial of 2,500 units may contain anywhere from 1,750 - 3,250 units per vial
• For nominal doses ≤ 2,500 units, the iCare order and label will be updated to exact units and dispensed from central pharmacy
• For nominal doses > 2,500 units, the iCare order and label will be updated to exact units and volume and dispensed from PSP
5. Hemophilia
1. FEIBA may also be ordered for its FDA approved indication: Control and prevention of bleeding episodes in patients with hemophilia

Please let me know if you have any questions or concerns.

Sincerely,
Monroe Crawley, Pharm.D.
PGY-2 Critical Care Pharmacy Resident