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Life-threatening upper gastrointestinal bleeding on apixaban — SCE Acute Medicine MCQ

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ModerateGastroenterology and hepatologyLife-threatening upper gastrointestinal bleeding on apixabanSCE Acute Medicine

An 86-year-old woman on apixaban for atrial fibrillation presents with melaena and collapse. Blood pressure is 84/50 mmHg despite initial fluid, haemoglobin is 62 g/L and creatinine is 146 micromol/L. She took apixaban 3 hours ago. Endoscopy is being arranged urgently. What is the most appropriate next step in management?

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

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Correct answer: E — Activate major haemorrhage support and discuss specific reversal with haematology

Life-threatening GI bleeding on apixaban requires resuscitation, blood product support and urgent specialist discussion about reversal, such as andexanet alfa where locally indicated or prothrombin complex concentrate when appropriate. Vitamin K reverses warfarin, not apixaban. Endoscopy should proceed after stabilisation rather than waiting passively for drug clearance.

Reference: NICE CG141 upper GI bleeding; BSG/ESGE endoscopy and anticoagulant guidance; BNF DOAC reversal