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Knee osteoarthritis — MRCGP AKT MCQ

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HardKnee InjuriesKnee osteoarthritisMRCGP AKT

A patient taking apixaban has haemodynamic compromise from an uncontrolled gastrointestinal haemorrhage despite initial resuscitation and source-control planning. Which specific reversal option is recommended by NICE for this setting?

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Reveal the answer and explanation

Correct answer: C — Andexanet alfa within emergency specialist bleed management

The best answer is “Andexanet alfa within emergency specialist bleed management”. NICE recommends andexanet alfa as an option for reversing apixaban or rivaroxaban in adults with life-threatening or uncontrolled bleeding only when the bleed is gastrointestinal. It is delivered within emergency specialist care alongside resuscitation and definitive haemostasis, and carries thrombotic risk. Idarucizumab reverses dabigatran, vitamin K reverses vitamin-K antagonists and protamine is used for heparins. Activated charcoal is time-dependent and is not the specific reversal therapy here.

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