Oral Factor Xa (FXa) inhibitors, a growing class of direct-acting 
anticoagulants, are frequently used to prevent stroke and systemic embolism in 
patients with atrial fibrillation and to prevent and treat venous 
thromboembolism. These drugs reduce the risk of clotting at the expense of 
increasing the risk of bleeding, and currently they have no specific reversal 
agent. However, andexanet alfa, a recombinant modified FXa decoy molecule, is in 
a late-phase clinical trial in bleeding patients, and ciraparantag, a small 
molecule that appears to reverse many anticoagulants including the FXa 
inhibitors, is in development. This review summarizes the published data to date 
on both drugs, which have the potential to change the management approach to 
patients with FXa inhibitor-associated major hemorrhage.