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Major haemorrhage on DOAC — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHaematological EmergenciesMajor haemorrhage on DOACSCE Acute Medicine

A 78-year-old woman is assessed on the acute medical unit. She takes apixaban and presents with haematemesis and hypotension. Last dose was this morning and renal function is impaired. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: B — Stop anticoagulant and seek urgent haematology advice

Stop anticoagulant and seek urgent haematology advice is the best answer because major bleeding on a DOAC needs resuscitation, drug cessation and urgent advice about reversal strategy. Arrange urgent CT imaging before treatment is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Timing of last dose and renal function guide reversal decisions.

Reference: BNF; BSH anticoagulant bleeding guideline