Drag each monitoring or reversal statement to the anticoagulant it best matches.
Matrix Multiple Choice
Choose your responses, then check the answer.
Explanation
Unfractionated heparin is commonly titrated with aPTT or anti-factor Xa and can be reversed with protamine. Warfarin is monitored with INR; vitamin K and four-factor prothrombin complex concentrate may be used for urgent major-bleeding reversal. Idarucizumab specifically reverses dabigatran, while andexanet alfa can reverse apixaban's factor Xa effect in adults.
Quick answer Heparin: aPTT or anti-Xa and protamine. Warfarin: INR and vitamin K plus PCC. Dabigatran: idarucizumab. Apixaban: andexanet alfa.
Why this is correct Anticoagulants act at different points in coagulation, so the useful test and reversal strategy are not interchangeable. Protamine and vitamin K do not reverse apixaban, and idarucizumab is specific for dabigatran.
NCLEX decision rule Stabilize active bleeding first, identify the anticoagulant and last dose, then match the prescribed reversal strategy and monitor for thrombosis after reversal.
References
1FDA heparin prescribing information
2FDA warfarin prescribing information
3FDA idarucizumab prescribing information
4FDA apixaban prescribing information
Major-bleeding medication reconciliationFour adults arrive with significant bleeding while taking different anticoagulants. The nurse verifies the exact drug and last dose, supports stabilization, and anticipates drug-specific monitoring or reversal. Each statement has one best match.
Four-Factor PCC — A concentrate of vitamin K-dependent clotting factors used for rapid reversal of vitamin K antagonist effects in major bleeding.
Idarucizumab — A specific binding agent that reverses dabigatran anticoagulant activity.
Andexanet Alfa — A reversal agent that antagonizes the anticoagulant effect of certain factor Xa inhibitors such as apixaban.