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Secondary Source: ACC Expert Consensus on Anticoagulant-Related Bleeding (2017 reaffirmed) — MRCP Part 1 MCQ

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MediumCardiology / EndocrinologySecondary Source: ACC Expert Consensus on Anticoagulant-Related Bleeding (2017 reaffirmed)MRCP Part 1

A 64-year-old with AF on apixaban requires urgent endoscopy for active UGIB. What reversal option is appropriate?

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Reveal the answer and explanation

Correct answer: A — Andexanet alfa (if factor Xa inhibitor taken recently) or 4-factor PCC if unavailable

For life-threatening bleeding on factor Xa inhibitors, andexanet alfa is indicated when available; otherwise, 4-factor PCC is recommended. Protamine reverses heparin, not Xa inhibitors. Vitamin K does not reverse DOACs. Desmopressin is adjunctive only. Proceeding without reversal risks ongoing bleeding.

Reference: andexanet alfa is indicated when available; otherwise