skip to main content

Major upper GI bleeding on apixaban — SCE Acute Medicine MCQ

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

HardAcute GI PresentationsMajor upper GI bleeding on apixabanSCE Acute Medicine

A 79-year-old woman taking apixaban presents with melaena and dizziness. BP is 82/48 mmHg, HR 128, Hb is 64 g/L and lactate is 4.1 mmol/L. She has received two units of packed red cells and intravenous PPI; her last apixaban dose was three hours ago. 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: A — Arrange urgent endoscopy after resuscitation and discuss reversal with haematology

This is major upper GI bleeding with shock, requiring resuscitation, urgent endoscopy and specialist discussion about DOAC reversal. Waiting several days risks ongoing haemorrhage. Continuing apixaban during uncontrolled major bleeding is unsafe, although anticoagulation should be revisited after haemostasis. The decision is a balance of haemorrhage control now and thrombotic prevention later.

Reference: NICE CG141, BSG/ESGE antithrombotic endoscopy guideline, BNF