# 心房顫動服用apixaban之病人末次劑量90分鐘後因腦內出血就醫。適當處置?複選。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374979&lang=zh-tw  
> language: zh-TW  
> subject: Psychosocial Integrity  
> category: PSI

## 題目

心房顫動服用apixaban之病人末次劑量90分鐘後因腦內出血就醫。適當處置?複選。

1

給予protamine sulfate中和apixaban

2

給予andexanet alfa作為apixaban之標靶拮抗劑

3

若無andexanet,給予4因子PCC

4

將收縮壓降至約140 mmHg

5

以新鮮冷凍血漿4單位作為首選拮抗

## 解析

Apixaban為直接Xa因子抑制劑。標靶拮抗為andexanet alfa,若無則用4F-PCC(50 IU/kg)。FFP無法可靠拮抗DOAC,已不推薦。Protamine拮抗肝素,對apixaban無效。自發性ICH:收縮壓降至約140 mmHg減少血腫擴大。Idarucizumab拮抗dabigatran(非apixaban)。

## 深入解析

拮抗整理:warfarin→4F-PCC+維生素K、dabigatran→idarucizumab、apixaban/rivaroxaban→andexanet alfa、肝素→protamine、LMWH→部分protamine。

## 臨床情境

GCS 12、BP 196/108、apixaban最末次0700、體重78 kg、近期未用PCC。

## 重要概念

- **Andexanet alfa** — 重組Xa因子誘餌 — 結合並拮抗apixaban/rivaroxaban。
- **4F-PCC** — 4因子凝血酶原複合體 — 拮抗warfarin,以及無標靶藥時的DOAC。
- **Idarucizumab** — 拮抗dabigatran之單株抗體片段。

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