# A client recently had an epidural catheter removed and apixaban was resumed. Review the trend and select the best interpretation and action.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522058&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client recently had an epidural catheter removed and apixaban was resumed. Review the trend and select the best interpretation and action.

| Time | Data |
| --- | --- |
| 0900 | Epidural catheter removed; leg strength is equal; no back pain; bladder function is normal |
| 1700 | Apixaban resumed according to the authorized plan; mild local soreness only |
| 2300 | Severe midline back pain; progressive bilateral leg weakness; difficulty initiating urination |

Q1. Which complication is most concerning?

Expected catheter-site soreness
Spinal or epidural hematoma with neurologic compromise
Delayed uncomplicated muscle strain

Q2. Which action is the priority?

Urgently notify the authorized team and activate neurologic and procedural evaluation
Give the next anticoagulant dose and reassess next shift
Encourage walking to relieve the back pain

## Explanation

Progressive severe back pain, bilateral leg weakness, and bladder dysfunction after neuraxial instrumentation indicate possible spinal or epidural hematoma and require urgent neurologic and procedural evaluation.

## In-depth explanation

Quick answer
Treat the trend as possible neuraxial hematoma with spinal-cord compression.

Why this is correct
Apixaban carries a boxed warning for spinal or epidural hematoma after neuraxial procedures. New sensory, motor, back-pain, or bowel and bladder changes require urgent evaluation because delay can lead to permanent paralysis.

Easy analogy or mental picture
A small closed spinal space cannot tolerate expanding blood without pressing on nerves.

Memory hook
After epidural plus anticoagulant: back pain, weakness, bladder change is an emergency.

NCLEX decision rule
Escalate the neurologic trend; do not treat it as routine post-procedure discomfort.

Why the other choices are wrong
Waiting for the next routine round or giving only an analgesic delays evaluation of a time-sensitive complication.References
1FDA: ELIQUIS Prescribing InformationSpinal or epidural hematoma warning, neurologic monitoring, and urgent treatment when compromise develops

## Clinical scenario

Neuraxial anticoagulant screen
Record catheter timing, anticoagulant timing, back pain, motor and sensory findings, bowel and bladder function, platelet status, and urgent escalation.

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