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Rivaroxaban-associated life-threatening GI bleeding — SCE Acute Medicine MCQ

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HardGastroenterology and hepatologyRivaroxaban-associated life-threatening GI bleedingSCE Acute Medicine

A patient took rivaroxaban three hours ago and now has ongoing haematemesis with shock despite resuscitation. Endoscopic control is being organised. What anticoagulant-specific action is appropriate?

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Correct answer: A — Consider andexanet alfa for rivaroxaban-associated major bleeding

The best answer is “Consider andexanet alfa for rivaroxaban-associated major bleeding”. under NICE criteria because andexanet is an option for apixaban- or rivaroxaban-related life-threatening or uncontrolled GI bleeding. Timing, last dose and local major-haemorrhage protocol matter; PCC may be used where appropriate specialist pathways direct. Vitamin K, protamine, INR and idarucizumab do not specifically reverse rivaroxaban.

Reference: NICE TA697 andexanet-alfa recommendations: https://www.nice.org.uk/guidance/ta697/chapter/1-Recommendations