A client on apixaban for atrial fibrillation presents with intracerebral hemorrhage 90 minutes after the last dose. Which interventions are appropriate? Select all that apply.

Select All That Apply

Choose your responses, then check the answer.

1 Administer protamine sulfate to neutralize the apixaban 2 Administer andexanet alfa as the targeted reversal agent for apixaban 3 Administer 4-factor prothrombin complex concentrate if andexanet is unavailable 4 Lower systolic blood pressure to a target around 140 mm Hg 5 Administer fresh frozen plasma 4 units as first-line reversal

Explanation

Apixaban is a direct factor Xa inhibitor. Targeted reversal is andexanet alfa; if unavailable, 4F-PCC (50 units/kg) is the recommended alternative. FFP does NOT reliably reverse direct oral anticoagulants and is no longer recommended. Protamine reverses HEPARIN, not apixaban. Aggressive BP control to a systolic around 140 mm Hg reduces hematoma expansion in spontaneous ICH. Idarucizumab reverses dabigatran (NOT apixaban).

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A client on apixaban for atrial fibrillation presents with intracerebral hemorrhage 90 minutes after the last dose. Which interventions are appropriate? Select all that apply.

Select All That Apply

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