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1. What is the cause of bleeding events, such as intracranial hemorrhage, in patients receiving oral anticoagulation?

A. the mechanism of the anticoagulant, such as vitamin K inhibition or factor Xa inhibition B. damage or rupture to large or small blood vessels C. both A and B (anticoagulant use plus damage to blood vessels) D. concomitant use of antiplatelet agents E. Unsure

2. What is the estimated risk of intracranial hemorrhage (ICH) for patients receiving a direct-acting oral anticoagulant (DOAC) compared with an oral vitamin K antagonist (warfarin)?

A. ICH risk for a patient receiving a DOACs is about 25% lower than for those receiving a vitamin K antagonist B. ICH risk for a patient receiving a DOACs is about 50% lower than for those receiving a vitamin K antagonist C. The risk for ICH is approximately equivalent for both DOACs and warfarin, but DOACs are more easily reversible D. The risk of ICH for DOACs is equivalent to that of warfarin, but mortality rates are higher E. Unsure

3. The preferred treatment strategy for acute anticoagulant-associated bleeding in a patient on warfarin therapy is:

A. exogenous vitamin K B. andexanet alfa C. prothrombin complex concentrate (PCC) D. idarucizumab E. Unsure

4. Reversal of direct oral anticoagulants (DOACs) that act via a direct thrombin inhibitor is best achieved using what method or agent?

A. Idarucizumab B. ciraparantag C. andexanet alfa D. prothrombin complex concentrate (PCC) E. Unsure

5. Which of the following statements is accurate regarding agents for reversal of direct-acting oral anticoagulants (DOACs?)

A. Idarucizimab is indicated for reversal of Factor Xa inhibitors, including rivaroxaban and apixaban B. Andexanet alfa is indicated only for reversal of dabigatran, which is a direct thrombin inhibitor C. Andexanet alfa is indicated for reversal of anticoagulation in patients treated with Factor Xa inhibitors, including rivaroxaban and apixaban D. Ciraparantag is approved for reversal of both direct thrombin inhibitors and Factor Xa inhibitors E. Unsure

6. According to the ACC Expert Consensus Decision Pathway, what are the three primary criteria for management of bleeding in a patient on an oral anticoagulant?

A. Older age, use of a vitamin K antagonist for ≥ 3 years; evidence of major bleeding B. Older age, use of anticoagulant (warfarin or DOAC) for ≥6 months, bleeding at a critical site C. Evidence of internal bleeding, need for administration of ≥2 units of red blood cells, previous intracranial hemorrhage D. Bleeding at a critical site, hemodynamic instability, clinically overt bleeding (hemoglobin decrease or need for red blood cells) E. Unsure

7. The mechanism of andexanet alfa as a DOAC reversal strategy is:

A. removal of clotting Factor Xa from the bloodstream B. binding to dabigatran to disable its anticoagulant effect C. direct binding to the Factor Xa inhibitors apixaban and rivaroxaban only D. direct binding to any Factor Xa inhibitor E. Unsure

8. Strategies for selection of a low dose (400 mg bolus, 4 mg/minute infusion) versus a high dose (800 mg bolus, 8 mg/minute infusion) of andexanet alfa are determined by:

A. which DOAC the patient took B. the timing of the patient's last DOAC dose C. the volume of distribution of the drug D. all of the above E. Unsure

9. A guideline statement that discusses the criteria for a major versus minor bleeding event, current DOAC reversal strategies, and when to restart anticoagulation is:

A. 2020 American College of Cardiology (ACC) Consensus Decision Pathway B. 2018 CHEST Guideline on Antithrombotic Therapy for Atrial Fibrillation C. 2018 American Society of Hematology (ASH) Venous Thromboembolism Treatment Guidelines D. All of the above E. Unsure

10. Revised National Patient Safety Goals from The Joint Commission, relating to anticoagulation management in the hospital, stipulate that:

A. Institutions must follow the ACC consensus decision pathway for reversal of oral anticoagulation B. Institutions may develop a protocol, or may allow clinicians to act independently according to local best practices C. Institutions must develop a protocol for management of oral anticoagulant-associated bleeding D. Institutions must report all bleeding events to the Joint Commission E. Unsure

Maintenance is scheduled for 8/7/2023 7:00 AM EST - 8:00 AM EST.

{{recommendationsA.Title}}

{{recommendationsB.Title}}

1. What is the cause of bleeding events, such as intracranial hemorrhage, in patients receiving oral anticoagulation?

2. What is the estimated risk of intracranial hemorrhage (ICH) for patients receiving a direct-acting oral anticoagulant (DOAC) compared with an oral vitamin K antagonist (warfarin)?

3. The preferred treatment strategy for acute anticoagulant-associated bleeding in a patient on warfarin therapy is:

4. Reversal of direct oral anticoagulants (DOACs) that act via a direct thrombin inhibitor is best achieved using what method or agent?

5. Which of the following statements is accurate regarding agents for reversal of direct-acting oral anticoagulants (DOACs?)

6. According to the ACC Expert Consensus Decision Pathway, what are the three primary criteria for management of bleeding in a patient on an oral anticoagulant?

7. The mechanism of andexanet alfa as a DOAC reversal strategy is:

8. Strategies for selection of a low dose (400 mg bolus, 4 mg/minute infusion) versus a high dose (800 mg bolus, 8 mg/minute infusion) of andexanet alfa are determined by:

9. A guideline statement that discusses the criteria for a major versus minor bleeding event, current DOAC reversal strategies, and when to restart anticoagulation is:

10. Revised National Patient Safety Goals from The Joint Commission, relating to anticoagulation management in the hospital, stipulate that:

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Maintenance is scheduled for 8/7/2023 7:00 AM EST - 8:00 AM EST.

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{{recommendationsA.Title}}

{{recommendationsB.Title}}

1. What is the cause of bleeding events, such as intracranial hemorrhage, in patients receiving oral anticoagulation?

2. What is the estimated risk of intracranial hemorrhage (ICH) for patients receiving a direct-acting oral anticoagulant (DOAC) compared with an oral vitamin K antagonist (warfarin)?

3. The preferred treatment strategy for acute anticoagulant-associated bleeding in a patient on warfarin therapy is:

4. Reversal of direct oral anticoagulants (DOACs) that act via a direct thrombin inhibitor is best achieved using what method or agent?

5. Which of the following statements is accurate regarding agents for reversal of direct-acting oral anticoagulants (DOACs?)

6. According to the ACC Expert Consensus Decision Pathway, what are the three primary criteria for management of bleeding in a patient on an oral anticoagulant?

7. The mechanism of andexanet alfa as a DOAC reversal strategy is:

8. Strategies for selection of a low dose (400 mg bolus, 4 mg/minute infusion) versus a high dose (800 mg bolus, 8 mg/minute infusion) of andexanet alfa are determined by:

9. A guideline statement that discusses the criteria for a major versus minor bleeding event, current DOAC reversal strategies, and when to restart anticoagulation is:

10. Revised National Patient Safety Goals from The Joint Commission, relating to anticoagulation management in the hospital, stipulate that:

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