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Perioperative Anticoagulation — UKMLA MCQ

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HardPharmacologyPerioperative AnticoagulationUKMLAMRCP Part 1MRCEM SBAPSA

A patient taking apixaban has life-threatening uncontrolled gastrointestinal bleeding despite initial resuscitation and local haemostatic measures. Which specific reversal treatment is recommended within NICE criteria?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Andexanet alfa as targeted reversal treatment

The best answer is “Andexanet alfa as targeted reversal treatment”. Andexanet alfa is the targeted reversal option recommended by NICE within its marketing authorisation for life-threatening or uncontrolled gastrointestinal bleeding caused by apixaban or rivaroxaban. Vitamin K reverses vitamin-K antagonists, protamine incompletely reverses heparins, and idarucizumab is specific to dabigatran. Tranexamic acid may have context-specific haemostatic roles but does not neutralise factor-Xa inhibition.

Reference: NICE TA697, Andexanet alfa for reversing apixaban or rivaroxaban: https://www.nice.org.uk/guidance/ta697/chapter/1-Recommendations