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Intracerebral haemorrhage on anticoagulation — SCE Neurology MCQ

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HardStrokeIntracerebral haemorrhage on anticoagulationSCE Neurology

A 76-year-old woman on apixaban for atrial fibrillation presents with sudden headache, vomiting and right-sided weakness. CT brain shows a 35 mL left basal ganglia haemorrhage with intraventricular extension. Blood pressure is 198/104 mmHg. Platelets and fibrinogen are normal. What is the most appropriate management?

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Reveal the answer and explanation

Correct answer: D — Reverse factor Xa inhibition and lower blood pressure

Reverse factor Xa inhibition and lower blood pressure is the best answer. DOAC-associated intracerebral haemorrhage requires urgent reversal where available and rapid blood pressure management. Alteplase and aspirin worsen bleeding; therapeutic heparin is contraindicated acutely; lumbar puncture is unnecessary with diagnostic CT haemorrhage. Clinical pearl: The first haemorrhage tasks are reversal, pressure control, neurosurgical discussion where indicated and supportive care.

Reference: NICE NG128; RCP Stroke Guideline; BNF