What would be the appropriate emergency intervention for a patient experiencing major bleeding while on apixaban?

The appropriate emergency intervention for a patient experiencing major bleeding while on apixaban is andexanet. Apixaban is a direct oral anticoagulant (DOAC) that works by inhibiting Factor Xa, which plays a crucial role in the coagulation cascade. When a patient on apixaban experiences significant bleeding, it is essential to reverse the anticoagulant effect to restore normal hemostasis.

Andexanet is specifically designed as an antidote for Factor Xa inhibitors, including apixaban. It acts by binding to the drug, thereby reversing its anticoagulant effects and helping to restore the blood's ability to clot effectively. In cases of major bleeding, rapid reversal of apixaban is vital, and andexanet provides a targeted approach to achieve that.

In contrast, vitamin K is primarily used to reverse anticoagulation from vitamin K antagonists like warfarin and does not have a role in reversing the effects of apixaban. Four-factor prothrombin complex concentrate can be used in the management of bleeding, but it is not as specific or effective for reversing direct Factor Xa inhibitors compared to andexanet. Idarucizumab is solely an antidote for dabigatran, another type of DOAC