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DOAC Reversal Emergency Bleeding — FRCA Final MCQ

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HardTrauma & Emergency AnaesthesiaDOAC Reversal Emergency BleedingFRCA Final

A 55-year-old man with chronic atrial fibrillation and a CHA2DS2-VASc score of 4 is on apixaban 5 mg BD. He develops acute upper GI bleeding requiring emergency endoscopy. The last dose of apixaban was 6 hours ago. Should a reversal agent be administered?

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Reveal the answer and explanation

Correct answer: B — Administer FFP 15 mL/kg

For life-threatening bleeding on apixaban where urgent reversal is required, andexanet alfa is the specific licensed reversal agent (binds and sequesters factor Xa inhibitors). If unavailable, PCC (4-factor, 25-50 IU/kg) is the recommended alternative providing partial reversal. FFP and vitamin K are ineffective against direct factor Xa inhibitors. Assessment should consider the 6h since last dose — significant anticoagulant effect remains.

Reference: BSH – 2023 – Management of bleeding in patients on DOACs