TBI-13 · Pediatric and Geriatric Traumatic Brain Injury

Pediatric and Geriatric Traumatic Brain Injury. Part of the Traumatic Brain Injury series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: For rivaroxaban and apixaban, the specific FDA-approved reversal agent is andexanet alfa, which acts as a decoy molecule binding up the inhibitor. — Correct: Andexanet alfa is no longer a current US answer. The FDA concluded that its risks outweighed its benefits, the manufacturer requested withdrawal of the licence, and US commercial sales ended on December 22, 2025. Its FDA indication was always apixaban and rivaroxaban only, never edoxaban, so the episode is right that edoxaban was excluded. Factor Xa inhibitor reversal in the US now follows the institutional emergency protocol, most commonly off-label four-factor prothrombin complex concentrate at 50 units per kilogram; do not delay reversal hunting for andexanet. Treat the decoy mechanism and the bolus-plus-infusion regimen as mechanism questions, separate from what you would actually give today. Authority: the FDA safety communication on Andexxa. The warfarin (four-factor PCC plus IV vitamin K) and dabigatran (idarucizumab 5 g as two 2.5 g infusions) pairings in the same passage are correct. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/TBI-13.