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Andexanet Alfa Apixaban Reversal CKD — ESENeph MCQ

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HardAcute Kidney InjuryAndexanet Alfa Apixaban Reversal CKDESENeph

A haemodialysis patient taking apixaban has haemodynamic collapse from an uncontrolled upper gastrointestinal bleed. The last dose was four hours ago. Which statement accurately reflects NICE TA697?

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

Reveal the answer and explanation

Correct answer: C — Andexanet alfa is an NHS option because this is life-threatening gastrointestinal bleeding

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · C = shown as D · A = shown as E

B is correct. NICE recommends andexanet alfa for adults with life-threatening or uncontrolled bleeding from apixaban or rivaroxaban only when the bleed is gastrointestinal, subject to the commercial arrangement. This is narrower than the drug’s pharmacological ability to bind factor-Xa inhibitors. TA697 does not make andexanet routine for urgent surgery without bleeding or for every other bleeding site. Idarucizumab reverses dabigatran, and vitamin K reverses warfarin. Resuscitation, haemorrhage control, timing of the last dose and local major-bleed protocol proceed alongside reversal.

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