# Drag each monitoring or reversal statement to the anticoagulant it best matches.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393517&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Drag each monitoring or reversal statement to the anticoagulant it best matches.

**1.** The infusion is commonly titrated using aPTT or an anti-factor Xa assay

Select a category
Apixaban
Warfarin
Dabigatran
Unfractionated heparin

**2.** Protamine sulfate is the expected specific reversal medication

Select a category
Apixaban
Warfarin
Dabigatran
Unfractionated heparin

**3.** The INR is the key routine test used to adjust therapy

Select a category
Apixaban
Warfarin
Dabigatran
Unfractionated heparin

**4.** Urgent major-bleeding reversal may include vitamin K and four-factor PCC

Select a category
Apixaban
Warfarin
Dabigatran
Unfractionated heparin

**5.** This medication directly inhibits thrombin

Select a category
Apixaban
Warfarin
Dabigatran
Unfractionated heparin

**6.** Idarucizumab is the specific reversal agent

Select a category
Apixaban
Warfarin
Dabigatran
Unfractionated heparin

**7.** This medication directly inhibits factor Xa

Select a category
Apixaban
Warfarin
Dabigatran
Unfractionated heparin

**8.** Andexanet alfa may be used for reversal in an adult with life-threatening bleeding

Select a category
Apixaban
Warfarin
Dabigatran
Unfractionated heparin

## 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.

## In-depth explanation

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

## Clinical scenario

Major-bleeding medication reconciliation
Four 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.

## Key concepts

- **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.

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